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General NPI Number Information
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NPI Number | 1720656721
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Entity Type | Individual
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Provider Name | MARILYN OJEHONMON
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 6018 VARIEL AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-3719
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Country | US
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Telephone | 818-996-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 VANALDEN AVE UNIT 203
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4839
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Country | US
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Telephone | 213-284-8970
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 96000155
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License Number State | CA
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