Provider Demographics
NPI:1427873090
Name:MARTINEZ MARAVILLA, DANNA P (MSW INTEM)
Entity type:Individual
Prefix:MS
First Name:DANNA
Middle Name:P
Last Name:MARTINEZ MARAVILLA
Suffix:
Gender:F
Credentials:MSW INTEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 E DORSET AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5504
Mailing Address - Country:US
Mailing Address - Phone:805-458-1493
Mailing Address - Fax:
Practice Address - Street 1:THE WHOLE CHILD
Practice Address - Street 2:10155 COLIMA ROAD
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-692-0383
Practice Address - Fax:562-692-0380
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program