Healthcare Provider Details

I. General information

NPI: 1285101444
Provider Name (Legal Business Name): MARINA KOCHANZHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N LA CIENEGA BLVD STE 203
WEST HOLLYWOOD CA
90069-2493
US

IV. Provider business mailing address

14674 TUPPER ST
PANORAMA CITY CA
91402-1244
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-1077
  • Fax:
Mailing address:
  • Phone: 916-317-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number295548
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: