Healthcare Provider Details

I. General information

NPI: 1538022637
Provider Name (Legal Business Name): MARVIN CARRADINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

10729 NEW HAVEN ST
SUN VALLEY CA
91352-3406
US

IV. Provider business mailing address

10729 NEW HAVEN ST
SUN VALLEY CA
91352-3406
US

V. Phone/Fax

Practice location:
  • Phone: 320-220-4428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberD0082031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: