Provider Demographics
NPI:1033164579
Name:MARINA KOVALEVSKY, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARINA KOVALEVSKY, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-650-3335
Mailing Address - Street 1:7737 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6269
Mailing Address - Country:US
Mailing Address - Phone:323-650-3335
Mailing Address - Fax:323-650-3337
Practice Address - Street 1:7737 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6269
Practice Address - Country:US
Practice Address - Phone:323-650-3335
Practice Address - Fax:323-650-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty