Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 106714 | CA |
Y | 213EG0000X | General Practice | 106714 | CA |
NPI | 1003589979 |
---|---|
Provider Name | Dr. Rebeca Marin |
First Address | Wilmington, CA 90744-2621 |
Second Address | Los Angeles, CA 90011-1235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |