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General NPI Number Information
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NPI Number | 1255221487
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Entity Type | Individual
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Provider Name | DIANNE MARIN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4021 OCEAN DR
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-3162
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Country | US
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Telephone | 949-244-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 4455 W 117TH ST STE 300
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City | HAWTHORNE
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State | CA
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Zip | 90250-2240
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Country | US
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Telephone | 310-987-0599
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F07250067
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License Number State | CA
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