Provider Demographics
NPI:1538651765
Name:ELORZA, MARRAH D Z (PSY D)
Entity type:Individual
Prefix:
First Name:MARRAH
Middle Name:D Z
Last Name:ELORZA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 N SAN FERNANDO RD # 1004
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1417
Mailing Address - Country:US
Mailing Address - Phone:213-479-8131
Mailing Address - Fax:
Practice Address - Street 1:3360 N SAN FERNANDO RD # 1004
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1417
Practice Address - Country:US
Practice Address - Phone:213-479-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32628103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist