Provider Demographics
NPI:1295980241
Name:MARAVILLA, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MARAVILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CAYUGA ST
Mailing Address - Street 2:#7
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2684
Mailing Address - Country:US
Mailing Address - Phone:831-796-3026
Mailing Address - Fax:
Practice Address - Street 1:150 CAYUGA ST
Practice Address - Street 2:#7
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2684
Practice Address - Country:US
Practice Address - Phone:831-796-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker