Healthcare Provider Details

I. General information

NPI: 1134897598
Provider Name (Legal Business Name): ELENA CRISTIANA MARIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 12/04/2025
Reactivation Date: 01/16/2026

III. Provider practice location address

4401 ATLANTIC AVE
LONG BEACH CA
90807-2218
US

IV. Provider business mailing address

4401 ATLANTIC AVE
LONG BEACH CA
90807-2218
US

V. Phone/Fax

Practice location:
  • Phone: 562-349-0084
  • Fax:
Mailing address:
  • Phone: 562-349-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95017870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: