Provider Demographics
NPI:1003271388
Name:MARINPONG, PASANAN
Entity Type:Individual
Prefix:
First Name:PASANAN
Middle Name:
Last Name:MARINPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LINCOLN AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4309
Mailing Address - Country:US
Mailing Address - Phone:309-750-6470
Mailing Address - Fax:
Practice Address - Street 1:1253 VINE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1662
Practice Address - Country:US
Practice Address - Phone:323-960-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist