Provider Demographics
NPI:1144731274
Name:ORDORICA, MARILYN LISA
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:LISA
Last Name:ORDORICA
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 1:8950 VILLA LA JOLLA DR STE C121
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1707
Mailing Address - Country:US
Mailing Address - Phone:877-876-3783
Mailing Address - Fax:855-420-6402
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C121
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:877-876-3783
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2022-09-28
Deactivation Date:2018-05-23
Deactivation Code:
Reactivation Date:2018-05-31
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA90665101YM0800X
CA1076501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health