Provider Demographics
NPI:1689910390
Name:BUSSEL, MARINA (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARINA
Middle Name:
Last Name:BUSSEL
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 1:13031 VILLOSA PL APT 424
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-6503
Mailing Address - Country:US
Mailing Address - Phone:310-948-0602
Mailing Address - Fax:
Practice Address - Street 1:13031 VILLOSA PL
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-6502
Practice Address - Country:US
Practice Address - Phone:310-948-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA730152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry