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General NPI Number Information
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NPI Number | 1851464739
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Entity Type | Individual
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Provider Name | MARINA DSOUZA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 1300 W 155TH ST
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City | GARDENA
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State | CA
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Zip | 90247-4048
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Country | US
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Telephone | 310-512-8100
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Fax | 310-324-2111
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Provider Business Mailing Address
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Address Line | 27416 WARRIOR DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-3752
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Country | US
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Telephone | 310-409-8141
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A36091
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License Number State | CA
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