Provider Demographics
NPI:1972323210
Name:MAREZ, KRISTYN N
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:N
Last Name:MAREZ
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 1:12544 BAR HARBOR ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4826
Mailing Address - Country:US
Mailing Address - Phone:909-693-6937
Mailing Address - Fax:
Practice Address - Street 1:560 E HOSPITALITY LN STE 400
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3545
Practice Address - Country:US
Practice Address - Phone:909-891-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2025-01-16
Deactivation Date:2024-12-17
Deactivation Code:
Reactivation Date:2025-01-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician