Healthcare Provider Details

I. General information

NPI: 1518632074
Provider Name (Legal Business Name): MARICAR RELLORA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

IV. Provider business mailing address

8405 BEVERLY BLVD
LOS ANGELES CA
90048-3401
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone: 323-653-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: