Provider Information for 1629164991
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Mr. JESSE MAREZ LCSW
Sex: Male
NPI: 1629164991
Last Updated: 2016-09-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1629164991 | ||||||||
| Enumeration Date | 2006-10-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1841 5TH AND WESTERN NORCO, CA 92860-0991 United States Phone: 951-737-2683 | Fax: | ||||||||
| Primary Practice Address | 23119 COTTONWOOD AVE BLD A SUITE 110 MORENO VALLEY, CA 92553-9661 United States Phone: 951-413-5678 | Fax: | ||||||||
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