Healthcare Provider Details

I. General information

NPI: 1154356699
Provider Name (Legal Business Name): MERCEDES F. MARUSCAK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST 100-B
GLENDALE CA
91204-2849
US

IV. Provider business mailing address

10844 ROSE AVE #7
LOS ANGELES CA
90034-5316
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-7611
  • Fax: 818-637-5106
Mailing address:
  • Phone: 310-815-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberNP13515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: