Provider Demographics
NPI:1164761300
Name:MARIANNA SHAKHNOVITS, MD APROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARIANNA SHAKHNOVITS, MD APROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKHNOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-446-9634
Mailing Address - Street 1:938 PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6122
Mailing Address - Country:US
Mailing Address - Phone:323-837-5147
Mailing Address - Fax:323-725-5063
Practice Address - Street 1:938 PALOMA DRIVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:323-837-5147
Practice Address - Fax:323-725-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty