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General NPI Number Information
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NPI Number | 1124858758
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Entity Type | Individual
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Provider Name | MARINA WILSON RIAD PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 590 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90004-2115
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Country | US
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Telephone | 323-284-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 10413 BELLDER DR
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City | DOWNEY
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State | CA
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Zip | 90241-2632
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA66018
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License Number State | CA
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