Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY12536 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY12536 | CA |
NPI | 1003825290 |
---|---|
Provider Name | Dr. Mari Marks |
First Address | Los Angeles, CA 90028-8029 |
Second Address | Los Angeles, CA 90028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 18/04/2019 |