Provider Demographics
NPI:1346333440
Name:BURSTEIN, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BURSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24013 VENTURA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1447
Mailing Address - Country:US
Mailing Address - Phone:818-222-2443
Mailing Address - Fax:818-222-2491
Practice Address - Street 1:24013 VENTURA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1447
Practice Address - Country:US
Practice Address - Phone:818-222-2443
Practice Address - Fax:818-222-2491
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536040Medicaid
CA00A536040Medicaid