Provider Demographics
NPI:1366645541
Name:MARVIZI, ROSITA (DDS)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:
Last Name:MARVIZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROSITA
Other - Middle Name:MARVIZI
Other - Last Name:RAYHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6200 WILSHIRE BLVD
Mailing Address - Street 2:1110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5801
Mailing Address - Country:US
Mailing Address - Phone:323-931-3881
Mailing Address - Fax:323-931-3962
Practice Address - Street 1:6200 WILSHIRE BLVD
Practice Address - Street 2:1110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5801
Practice Address - Country:US
Practice Address - Phone:323-931-3881
Practice Address - Fax:323-931-3962
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist