MARISA LYNN TAVOLAZZI (NPI# 1952958043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952958043 |
| Entity Type | Individual |
| Full Name | MARISA LYNN TAVOLAZZI |
| Practice Address |
1664 Broadway El Cajon CA 92021-5201 |
| Practice Telephone | 6195798685 |
| Mailing Telephone | 6195798685 |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
1664 BROADWAY |
| City | EL CAJON |
| State | CA |
| Zip Code | 92021-5201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760556831 | Mary P Grossman | Counselor | 1664 Broadway, El Cajon, CA 92021-5201 | 2006-11-20 |
| 1578160008 | Janai Russell | Licensed Vocational Nurse | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-10-07 |
| 1427661370 | Parva Nouri | Counselor | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-08-28 |
| 1710599790 | Julie K Neill | Student in an Organized Health Care Education/Training Program | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-08-20 |
| 1508478769 | Susana Villalpando | Counselor | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-08-19 |
| 1528678729 | Sally Hana | Student in an Organized Health Care Education/Training Program | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-08-03 |
| 1851901029 | Whitney Lyn Roque | Student in an Organized Health Care Education/Training Program | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-08-03 |
| 1477162600 | Augure Thomas | Licensed Vocational Nurse | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-07-23 |
| 1669080065 | Jennifer Nicole Lilly | Student in an Organized Health Care Education/Training Program | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-07-21 |
| 1730707993 | Jennifer Sandrock | Student in an Organized Health Care Education/Training Program | 1664 Broadway, El Cajon, CA 92021-5201 | 2020-07-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033728498 | Hala Kadhem | Counselor | 1664 Broadway, El Cajon, San Diego, CA 92021 | 2020-07-30 |
| 1891331021 | Medevac Inc | Ambulance | 8025 Tone Lane, El Cajon, CA 92021 | 2019-11-22 |
| 1760024095 | San Diego Health Alliance, Inc. | Clinic/Center | 1625 East Main Street, El Cajon, CA 92021 | 2019-10-08 |
| 1295388932 | Coleen Stacie Cobbs | Social Worker | 1013 Greta Street, El Cajon, CA 92021 | 2019-07-22 |
| 1144744475 | Sarah Kala | Pharmacist | 505 N Mollison Ave #102, El Cajon, CA 92021 | 2017-07-28 |
| 1699139816 | Mayra Aranda | Counselor | 1679 East Main Street, Suite 102, El Cajon, CA 92021 | 2016-04-13 |
| 1942603436 | Scott Crusey | Counselor | 1679 East Main Street, Suite 102, El Cajon, CA 92021 | 2014-09-29 |
| 1104254317 | Naimh Martin | Counselor | 1630 E Main Street, El Cajon, CA 92021 | 2013-10-25 |
| 1386875540 | Jacqueline Vu Luong | Marriage & Family Therapist | 1000 Broadway #100, El Cajon, CA 92021 | 2009-08-05 |
| 1740444264 | Peter Morhan Sun | General Practice | 7957 Bevin Lane, El Cajon, CA 92021 | 2008-07-14 |
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| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417590811 | Samaa Bazzi | Peer Specialist | 436 S Magnolia Ave # 101&201, El Cajon, CA 92020-5237 | 2019-10-18 |
| 1780161331 | Jennifer Roachford | Peer Specialist | 1679 E Main St Ste 102, El Cajon, CA 92021-5212 | 2018-07-26 |
| 1902392558 | Eduardo Chavez | Peer Specialist | 1060 Estes St, El Cajon, CA 92020-7515 | 2018-07-06 |
| 1780118562 | Teresa Ann Van Devere | Peer Specialist | 1060 Estes St, 104, El Cajon, CA 92020-7515 | 2017-04-18 |
| 1972957165 | Stacy Greene | Peer Specialist | 1664 Broadway, El Cajon, CA 92021-5201 | 2016-04-14 |
| 1336506963 | Guadalupe Perez | Peer Specialist | 460 N Magnolia Ave, El Cajon, CA 92020-3610 | 2016-01-27 |
| 1134505654 | Janine Hardman | Peer Specialist | 460 N Magnolia Ave, Suite 110, El Cajon, CA 92020-3610 | 2015-08-06 |
| 1184036659 | Alexandra Marie Signer | Peer Specialist | 460 N Magnolia Ave, El Cajon, CA 92020-3610 | 2014-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477629 | Karen J Pompa | Peer Specialist | 2605 E Date Palm Paseo Apt 2194, Ontario, CA 91764-4670 | 2020-11-05 |
| 1033710231 | Marcus Kujawa | Peer Specialist | 85 Ramona Expy Ste 13, Perris, CA 92571-7014 | 2020-11-04 |
| 1962001230 | Tanya Geanna Macleod | Peer Specialist | 474 West Vermont Ave., Ste., 101, Escondido, CA 92025 | 2020-10-19 |
| 1043826753 | Dayjahnay Shantay Davenport | Peer Specialist | 3347 Lincoln Ave, San Diego, CA 92104-2111 | 2020-09-17 |
| 1497364848 | Marissa Adrianna Garza | Peer Specialist | 1502 Verona Ct, Salinas, CA 93905-2249 | 2020-07-30 |
| 1235765801 | Jill Nina Bierman | Peer Specialist | 25322 Via Piedra Roja, Laguna Niguel, CA 92677-1824 | 2020-03-16 |
| 1427683101 | Gerardo Castro | Peer Specialist | 5555 Reservoir Dr # 204-a, San Diego, CA 92120-5134 | 2020-03-03 |
| 1437783180 | Samuel Guadron Rosales | Peer Specialist | 658 E Brier Dr Ste 250, San Bernardino, CA 92408-2875 | 2020-03-02 |
| 1356973234 | Salina Sheoli Romero | Peer Specialist | 40 West G Street Ste. B, Los Banos, CA 93635 | 2020-02-07 |
| 1578103313 | Charles Winfield Eproson Jr. | Peer Specialist | 4545 Georgetown Pl Ste D, Stockton, CA 95207-6229 | 2020-01-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.