Provider Demographics
NPI:1528949807
Name:URIBE-SEVILLA, MARILYN (MS, PPS)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:URIBE-SEVILLA
Suffix:
Gender:F
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25631 PETER A HARTMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3142
Mailing Address - Country:US
Mailing Address - Phone:949-586-1234
Mailing Address - Fax:
Practice Address - Street 1:25222 PERICIA DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5400
Practice Address - Country:US
Practice Address - Phone:949-830-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty