Healthcare Provider Details

I. General information

NPI: 1225597297
Provider Name (Legal Business Name): MARIANNA PAVLYHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA DRIVEWAY
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

757 WESTWOOD PLAZA VASCULAR SURGERY
LOS ANGELES CA
90095
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6294
  • Fax:
Mailing address:
  • Phone: 310-825-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA180451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: