Healthcare Provider Details

I. General information

NPI: 1639365133
Provider Name (Legal Business Name): MARISOL GARCIA PENICHET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W 7TH ST
LOS ANGELES CA
90057-4002
US

IV. Provider business mailing address

PO BOX 10432
BEVERLY HILLS CA
90213-3432
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-3434
  • Fax: 213-637-0924
Mailing address:
  • Phone: 213-637-2530
  • Fax: 213-637-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA84142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: