Healthcare Provider Details

I. General information

NPI: 1528296720
Provider Name (Legal Business Name): MARILYN HAYWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N LAKE AVE
PASADENA CA
91104-4521
US

IV. Provider business mailing address

150 PAINTER ST APT 6
PASADENA CA
91103-4126
US

V. Phone/Fax

Practice location:
  • Phone: 626-808-9746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: