Provider Demographics
NPI:1568627222
Name:SHAKHNOVITS, MARIANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:SHAKHNOVITS
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 1:101 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-837-5147
Mailing Address - Fax:
Practice Address - Street 1:101 W BEVERLY BLVD
Practice Address - Street 2:STE 303
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4316
Practice Address - Country:US
Practice Address - Phone:323-837-5147
Practice Address - Fax:323-725-5063
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113415207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine