Healthcare Provider Details

I. General information

NPI: 1013623891
Provider Name (Legal Business Name): REMO MARAYAG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 VAN NUYS BLVD
VAN NUYS CA
91405-1949
US

IV. Provider business mailing address

7536 SAINT CLAIR AVE
NORTH HOLLYWOOD CA
91605-3022
US

V. Phone/Fax

Practice location:
  • Phone: 818-627-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number709296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: