Provider Demographics
NPI:1396297313
Name:TABORGA, MARCIA P (PHD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:P
Last Name:TABORGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S ASSOCIATED RD # 433
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5802
Mailing Address - Country:US
Mailing Address - Phone:213-915-6093
Mailing Address - Fax:
Practice Address - Street 1:3350 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6264
Practice Address - Country:US
Practice Address - Phone:562-431-8822
Practice Address - Fax:562-431-8875
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical