MEDICARE: KRISS GOSS-MARR

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1619413101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISS GOSS-MARR

Provider Business Mailing Address
First Line	:	1853 TAFT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1853 TAFT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5706
Country	:	US
Telephone Number	:	323-366-2450
Fax Number	:

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

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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Directions to “ KRISS GOSS-MARR ” Practice Location

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