=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326369067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. RAYMOND MARS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2010
-----------------------------------------------------
Last Update Date | 06/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 W SLAUSON AVE SUITE 116
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-6523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-447-6194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5701 W SLAUSON AVE SUITE 116
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-6523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-447-6194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | PSY17945
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------