Healthcare Provider Details

I. General information

NPI: 1548720634
Provider Name (Legal Business Name): MARINA KOBRYN RN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16857 SAN FERNANDO MISSION BLVD UNIT 56
GRANADA HILLS CA
91344-4253
US

IV. Provider business mailing address

16857 SAN FERNANDO MISSION BLVD UNIT 56
GRANADA HILLS CA
91344-4253
US

V. Phone/Fax

Practice location:
  • Phone: 818-625-3264
  • Fax:
Mailing address:
  • Phone: 818-625-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number476190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: