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General NPI Number Information
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NPI Number | 1346977410
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Entity Type | Individual
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Provider Name | MARINA HENRY OD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1130 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3538
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Country | US
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Telephone | 310-323-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 AVENUE OF THE ARTS APT F224
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City | COSTA MESA
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State | CA
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Zip | 92626-7629
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Country | US
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Telephone | 713-517-4481
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10653TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35893TLG
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License Number State | CA
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