Healthcare Provider Details

I. General information

NPI: 1972875730
Provider Name (Legal Business Name): JONATHAN MAREHBIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9763 W PICO BLVD STE 200
LOS ANGELES CA
90035-4749
US

IV. Provider business mailing address

225 ASHDALE AVE
LOS ANGELES CA
90049-2404
US

V. Phone/Fax

Practice location:
  • Phone: 424-234-1118
  • Fax: 888-959-1481
Mailing address:
  • Phone: 310-613-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25841
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-11827
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number56920
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number55617
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA151052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: