Healthcare Provider Details

I. General information

NPI: 1619589942
Provider Name (Legal Business Name): SAMIN MALEK MARZBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE
LOS ANGELES CA
90089-4516
US

IV. Provider business mailing address

700 W 9TH ST APT 913
LOS ANGELES CA
90015-4516
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1369
  • Fax:
Mailing address:
  • Phone: 201-281-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: