Doctor Name: | MS. MARISELA BANDA |
NPI Number: | 1013377951 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CADACII |
License Number: | AII2921214 |
Business Practice Address: | 9140 Van Nuys Blvd 211 Panorama City, CA - 914026727 |
Business Phone Number: | 8188952206 |
Business Fax Number: | |
Mailing Address: | 9140 Van Nuys Blvd, 211 PANORAMA CITY |
State: | CA |
Postal Code: | 914026727 |
Phone Number: | 8188952206 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2016 |
NPI Last Update Date: | 03/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | AII2921214 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |