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General NPI Number Information
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NPI Number | 1588194534
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Entity Type | Organization
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Legal Business Name | MARISSAM MEDICAL INC.
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13508 INGLEWOOD AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250
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Country | US
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Telephone | 424-675-4222
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Fax | 424-675-4224
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Provider Business Mailing Address
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Address Line | 13508 INGLEWOOD AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-5604
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Country | US
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Telephone | 424-675-4222
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Fax | 424-675-4224
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Authorized Official
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Title or Position | OWNER
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Name | MARISSA J MOTLEY
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Credential |
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Telephone | 424-675-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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