Provider Demographics
NPI:1972152502
Name:MARCIAL, ANAHI
Entity type:Individual
Prefix:
First Name:ANAHI
Middle Name:
Last Name:MARCIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 570009
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-0009
Mailing Address - Country:US
Mailing Address - Phone:760-855-8165
Mailing Address - Fax:
Practice Address - Street 1:2772 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6206
Practice Address - Country:US
Practice Address - Phone:619-295-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90812101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health