Provider Demographics
NPI:1588493381
Name:MAILE, MARIAN (DC)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:MAILE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 1/2 SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3310
Mailing Address - Country:US
Mailing Address - Phone:310-699-1702
Mailing Address - Fax:
Practice Address - Street 1:4951 1/2 SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3310
Practice Address - Country:US
Practice Address - Phone:310-699-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor