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General NPI Number Information
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NPI Number | 1609475953
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Entity Type | Individual
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Provider Name | ANGELYNN MARIN
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 2101 MAGNOLIA AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-4521
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Country | US
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Telephone | 562-218-1868
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 W JEFFERSON BLVD APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90018-3960
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Country | US
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Telephone | 323-244-6906
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1404480920
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License Number State | CA
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