Provider Demographics
NPI:1710326574
Name:TOOSSI, MARMAR
Entity Type:Individual
Prefix:
First Name:MARMAR
Middle Name:
Last Name:TOOSSI
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 1:1439 S BUNDY DR APT T
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2132
Mailing Address - Country:US
Mailing Address - Phone:310-948-6310
Mailing Address - Fax:
Practice Address - Street 1:1439 S BUNDY DR APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2192
Practice Address - Country:US
Practice Address - Phone:310-948-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22411124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist