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General NPI Number Information
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NPI Number | 1881162147
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Entity Type | Individual
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Provider Name | MARYLOU ACLAN
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 14400 OLIVE VIEW DR
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City | SYLMAR
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State | CA
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Zip | 91342-1436
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Country | US
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Telephone | 747-210-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 27074 HIDAWAY AVE UNIT 6
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-4121
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Country | US
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Telephone | 818-731-1657
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95010201
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95010201
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License Number State | CA
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