MEDICARE: MARINA WHOLE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902420839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA WHOLE HEALTH

Provider Business Mailing Address
First Line	:	3635 SHANNON RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1420
Country	:	US
Telephone Number	:	310-923-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 BELLFLOWER BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1057
Country	:	US
Telephone Number	:	562-688-5485
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRISTAL SPELLER
Credential	:	MD, MPH
Telephone Number	:	310-923-3030

Provider Enumeration Date	:	06/06/2020
Last Update Date	:	06/06/2020

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