Healthcare Provider Details

I. General information

NPI: 1831529163
Provider Name (Legal Business Name): MARICRIS TOPICO SITJAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 250
GLENDALE CA
91205-4433
US

IV. Provider business mailing address

234 W FAIRVIEW AVE APT 207
GLENDALE CA
91202-2966
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: