Healthcare Provider Details

I. General information

NPI: 1255280772
Provider Name (Legal Business Name): MARISELA SERVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UNIVERSAL CITY PLZ
UNIVERSAL CITY CA
91608-1002
US

IV. Provider business mailing address

2413 MATHEWS AVE APT F
REDONDO BEACH CA
90278-3243
US

V. Phone/Fax

Practice location:
  • Phone: 213-709-5234
  • Fax:
Mailing address:
  • Phone: 213-709-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: