Provider Demographics
NPI:1538280268
Name:DYLAN, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DYLAN
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 1:11700 NATIONAL BLVD
Mailing Address - Street 2:L-118
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3669
Mailing Address - Country:US
Mailing Address - Phone:310-967-7958
Mailing Address - Fax:
Practice Address - Street 1:21355 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5250
Practice Address - Country:US
Practice Address - Phone:310-967-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist