MEDICARE: DR. MARI MARKS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY12536	CA

General Provider Information

NPI Number	:	1003825290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARI MARKS PHD

Provider Business Mailing Address
First Line	:	1800 VINE ST STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5249
Country	:	US
Telephone Number	:	310-472-2523
Fax Number	:	213-221-7070

Provider Business Practice Location Address
First Line	:	1800 VINE ST STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5249
Country	:	US
Telephone Number	:	310-472-2523
Fax Number	:	213-221-7070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/29/2026

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