Healthcare Provider Details

I. General information

NPI: 1003144718
Provider Name (Legal Business Name): MARISA DANBEE OH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE LAC-USC MED CTR- INTERNS/RESIDENTS BUILDING, ROOM 112
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

1107 W DUARTE RD UNIT B
ARCADIA CA
91007-7769
US

V. Phone/Fax

Practice location:
  • Phone: 626-241-0704
  • Fax:
Mailing address:
  • Phone: 626-241-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: