Provider Demographics
NPI:1144650995
Name:QUIROZ, MARIELA (SUDCCII)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:SUDCCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E OHIO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3439
Mailing Address - Country:US
Mailing Address - Phone:760-745-7786
Mailing Address - Fax:760-745-1061
Practice Address - Street 1:1905 APPLE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4455
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:760-547-1268
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7661101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)