Provider Demographics
NPI:1285227900
Name:GHOBRIAL, MARIAN FAITH V
Entity type:Individual
Prefix:
First Name:MARIAN FAITH
Middle Name:V
Last Name:GHOBRIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAN FAITH
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6557 GRAND CONCOURSE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8024
Mailing Address - Country:US
Mailing Address - Phone:714-624-1022
Mailing Address - Fax:
Practice Address - Street 1:930 S MOUNT VERNON AVE STE 90
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3928
Practice Address - Country:US
Practice Address - Phone:909-660-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NVLBA0702103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst