Provider Demographics
NPI:1639959661
Name:CHILYAN, MARINE
Entity Type:Individual
Prefix:
First Name:MARINE
Middle Name:
Last Name:CHILYAN
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 1:5260 RIVERTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3334
Mailing Address - Country:US
Mailing Address - Phone:818-381-6777
Mailing Address - Fax:
Practice Address - Street 1:5260 RIVERTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3334
Practice Address - Country:US
Practice Address - Phone:818-381-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily