Provider Demographics
NPI:1134952856
Name:ANDERSON, MARISSA N
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E 2ND ST APT 349
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4466
Mailing Address - Country:US
Mailing Address - Phone:228-238-7910
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST STE A7D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-4500
Practice Address - Country:US
Practice Address - Phone:323-409-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program