Individual
MARISA MARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
461 W 6TH ST, SUITE 204, SAN PEDRO, CA 90731-2694
(310) 547-0084
(310) 833-5672
Mailing address
461 W 6TH ST, SUITE 204, SAN PEDRO, CA 90731-2694
(310) 547-0084
(310) 833-5672
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY 19781
CA
Other
Enumeration date
10/03/2006
Last updated
08/25/2011
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