Provider Demographics
NPI:1427190404
Name:MOERKBAK, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MOERKBAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 498, 1000 W. CARSON ST.
Mailing Address - Street 2:HARBOR-UCLA MEDICAL CENTER, DEPARTMENT OF PSYCHIATRY
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90509
Mailing Address - Country:US
Mailing Address - Phone:310-222-1808
Mailing Address - Fax:310-328-7217
Practice Address - Street 1:BOX 498, 1000 W. CARSON ST.
Practice Address - Street 2:HARBOR-UCLA MEDICAL CENTER, DEPARTMENT OF PSYCHIATRY
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509
Practice Address - Country:US
Practice Address - Phone:310-222-1808
Practice Address - Fax:310-328-7217
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program