Organization
PACIFICA NEUROPSYCHOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISA MARES PH.D (CLINICAL DIRECTOR)
(310) 547-0084
Entity
Organization
Contact information
Practice address
461 W 6TH ST, SUITE 211, SAN PEDRO, CA 90731-2694
(310) 547-0084
(310) 833-5672
Mailing address
461 W 6TH ST, SUITE 211, 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
106H00000X
Marriage & Family Therapist
MFC 42200
CA
Other
Enumeration date
09/02/2011
Last updated
01/26/2017
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