Healthcare Provider Details

I. General information

NPI: 1386357358
Provider Name (Legal Business Name): BIANCA DESIREE DI MARZIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 WORSHAM AVE STE 101
LONG BEACH CA
90808-1734
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-5900
  • Fax: 562-799-8379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: