Healthcare Provider Details

I. General information

NPI: 1649570953
Provider Name (Legal Business Name): MARION JANET CZUBIAK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARION CARPENEDO CZUBIAK R.N.

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-6315
  • Fax: 213-738-4646
Mailing address:
  • Phone: 213-639-6315
  • Fax: 213-738-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number197640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: