Healthcare Provider Details

I. General information

NPI: 1578300083
Provider Name (Legal Business Name): MARINE ALTUNYAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1636 SINALOA AVE
PASADENA CA
91104-1530
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0527
  • Fax:
Mailing address:
  • Phone: 626-376-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number75760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: