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General NPI Number Information
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NPI Number | 1821537986
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Entity Type | Individual
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Provider Name | MARINE AZARAN DPT
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Gender | Female
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 4940 VAN NUYS BLVD STE 301
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1700
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Country | US
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Telephone | 818-907-0952
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Fax |
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Provider Business Mailing Address
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Address Line | 16161 VENTURA BLVD STE C564
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City | ENCINO
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State | CA
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Zip | 91436-2522
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Country | US
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Telephone | 818-907-0952
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Fax | 818-990-9449
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 291406
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License Number State | CA
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