Healthcare Provider Details

I. General information

NPI: 1073771572
Provider Name (Legal Business Name): SARA MARIE MARNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA MARIE SHAHID-SALESS

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS#76
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6430 W SUNSET BLVD SUITE 600
LOS ANGELES CA
90028-7900
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6927
  • Fax: 323-361-8566
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC54209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: