Provider Demographics
NPI:1861120024
Name:MAGSAYSAY, MARIEL LOUISE RAZON (BA)
Entity type:Individual
Prefix:
First Name:MARIEL LOUISE
Middle Name:RAZON
Last Name:MAGSAYSAY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 S BROADWAY FL 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2729
Mailing Address - Country:US
Mailing Address - Phone:323-234-4445
Mailing Address - Fax:
Practice Address - Street 1:5811 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5323
Practice Address - Country:US
Practice Address - Phone:323-234-4445
Practice Address - Fax:323-234-4477
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
171M00000X, 225400000X, 390200000X
CA1252941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program