Healthcare Provider Details

I. General information

NPI: 1922655711
Provider Name (Legal Business Name): MARIN KITAMURA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 IMPERIAL HWY STE C
DOWNEY CA
90242-3464
US

IV. Provider business mailing address

1525 W 158TH ST UNIT 1
GARDENA CA
90247-3801
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8525
  • Fax: 562-869-7786
Mailing address:
  • Phone: 310-499-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: