Provider Demographics
NPI:1942597737
Name:DILLON, MARYANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:UCLA PEDS I.D.- RM 22-442 MDCC,
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:310-206-6369
Mailing Address - Fax:310-825-9175
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:UCLA PEDS I.D.- RM 22-442 MDCC,
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-206-6369
Practice Address - Fax:310-825-9175
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA3895363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health