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General NPI Number Information
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NPI Number | 1184134892
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Entity Type | Organization
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Legal Business Name | MARINA ORTHO, INC.
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Dates
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Enumeration Date | 10/08/2017
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Last Update Date | 10/28/2017
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Provider Practice Location Address
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Address Line | 13160 MINDANAO WAY STE 300
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6393
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Country | US
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Telephone | 310-574-0367
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Fax |
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Provider Business Mailing Address
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Address Line | 13160 MINDANAO WAY STE 300
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6393
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Country | US
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Telephone | 310-574-0367
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DAWN MARIE KENNEDY
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Credential |
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Telephone | 310-574-0367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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