Provider Demographics
NPI:1851464739
Name:DSOUZA, MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:DSOUZA
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 1:27416 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3752
Mailing Address - Country:US
Mailing Address - Phone:310-409-8141
Mailing Address - Fax:
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4048
Practice Address - Country:US
Practice Address - Phone:310-512-8100
Practice Address - Fax:310-324-2111
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA360912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50312Medicare UPIN
CAA36091Medicare ID - Type Unspecified