Healthcare Provider Details

I. General information

NPI: 1285754986
Provider Name (Legal Business Name): MARIROSE OCCHIOGROSSO MFT, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 W GOLDLEAF CIR
LOS ANGELES CA
90056-1269
US

IV. Provider business mailing address

5105 GOLDLEAF CIRCLE KAISER PERMANENTE
LOS ANGELES CA
90056
US

V. Phone/Fax

Practice location:
  • Phone: 323-298-3130
  • Fax:
Mailing address:
  • Phone: 323-298-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 43857
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATR 06-098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: