MEDICARE: MARIN CRIVELLO

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	363LF0000X	Family Nurse Practitioner	NP95036549	CA

General Provider Information

NPI Number	:	1164384632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIN CRIVELLO

Provider Business Mailing Address
First Line	:	17434 BELLFLOWER BLVD # 2-187
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-6849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	323-900-5746
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	05/28/2026

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Directions to “ MARIN CRIVELLO ” Practice Location

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