Provider Demographics
NPI:1780620286
Name:SHLIFER, MARINA (DPM)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SHLIFER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14108 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1119
Mailing Address - Country:US
Mailing Address - Phone:805-239-9055
Mailing Address - Fax:818-981-3801
Practice Address - Street 1:20301 VENTURA BLVD
Practice Address - Street 2:STE 210
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0934
Practice Address - Country:US
Practice Address - Phone:818-981-0080
Practice Address - Fax:818-981-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3899213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E38990Medicaid
CAE3788Medicare ID - Type UnspecifiedMEDICARE
CAU43172Medicare UPIN