Provider Demographics
NPI:1730804055
Name:MARZOLF, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MARZOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 AVENIDA DE LOYOLA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3224
Mailing Address - Country:US
Mailing Address - Phone:831-345-3464
Mailing Address - Fax:
Practice Address - Street 1:2888 LOKER AVE E STE 309
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6686
Practice Address - Country:US
Practice Address - Phone:760-691-1513
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician