Individual
MARCIANA MENDOZA SAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8106 TILDEN AVE, PANORAMA CITY, CA 91402-5243
(818) 464-6551
Mailing address
8106 TILDEN AVE, PANORAMA CITY, CA 91402-5243
(818) 464-6551
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D5434171
CA
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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