Healthcare Provider Details

I. General information

NPI: 1942575360
Provider Name (Legal Business Name): MARILIN LOUROKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E WALNUT ST STE 110
PASADENA CA
91106-1877
US

IV. Provider business mailing address

10155 COLIMA RD
WHITTIER CA
90603-2042
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-5136
  • Fax:
Mailing address:
  • Phone: 626-200-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF67150
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: