1063894673 NPI number — MARINIA ACADEMY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063894673 NPI number — MARINIA ACADEMY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINIA ACADEMY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063894673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 S ASSOCIATED RD # 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92821-5802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-522-8240
Provider Business Mailing Address Fax Number:
800-522-8240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 S STATE COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BREA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92821-5823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-522-8240
Provider Business Practice Location Address Fax Number:
800-522-8240
Provider Enumeration Date:
06/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SAMBRANO
Authorized Official First Name:
SHANI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ OUTREACH COORDINATOR
Authorized Official Telephone Number:
800-522-8240

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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