Provider Demographics
NPI:1659371367
Name:FICINSKI, MARIOLA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIOLA
Middle Name:L
Last Name:FICINSKI
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 1:1245 WILSHIRE BLVD STE 817
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4808
Mailing Address - Country:US
Mailing Address - Phone:213-250-5255
Mailing Address - Fax:213-250-5265
Practice Address - Street 1:1245 WILSHIRE BLVD STE 817
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4808
Practice Address - Country:US
Practice Address - Phone:213-250-5255
Practice Address - Fax:213-250-5265
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50558207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505580Medicaid
110133236OtherRAILROAD MEDICARE
CAG31921Medicare UPIN
CA00A505580Medicaid