Healthcare Provider Details

I. General information

NPI: 1164384632
Provider Name (Legal Business Name): MARIN CRIVELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12840 RIVERSIDE DR
STUDIO CITY CA
91607-3327
US

IV. Provider business mailing address

17434 BELLFLOWER BLVD # 2-187
BELLFLOWER CA
90706-6849
US

V. Phone/Fax

Practice location:
  • Phone: 323-900-5746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95036549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: