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General NPI Number Information
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NPI Number | 1255900833
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Entity Type | Individual
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Provider Name | DYLAN MARKS
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Gender | Male
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 11101 W OLYMPIC BLVD STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90064-1805
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Country | US
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Telephone | 310-476-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 12340 MONTANA AVE APT 303
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City | LOS ANGELES
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State | CA
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Zip | 90049-5235
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 113866
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License Number State | CA
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