Provider Demographics
NPI:1730869744
Name:KWOBA, MARION REXELLA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:REXELLA
Last Name:KWOBA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARION
Other - Middle Name:
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 4TH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2800
Mailing Address - Country:US
Mailing Address - Phone:858-568-2733
Mailing Address - Fax:
Practice Address - Street 1:1121 4TH AVE APT 206
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2800
Practice Address - Country:US
Practice Address - Phone:858-568-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical