Provider Demographics
NPI:1194020339
Name:MARIN, MARCELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18139 SUNBURST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2714
Mailing Address - Country:US
Mailing Address - Phone:818-915-1011
Mailing Address - Fax:
Practice Address - Street 1:50 N LA CIENEGA BLVD
Practice Address - Street 2:STE. 217
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2227
Practice Address - Country:US
Practice Address - Phone:310-275-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist