Individual
VIRGIL EVAN GEALON MARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11301 WILSHIRE BLVD, LOS ANGELES, CA 90073-1003
(310) 478-3711
Mailing address
3744 TILDEN AVE, LOS ANGELES, CA 90034-6912
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
137142
CA
227900000X
Registered Respiratory Therapist
137142
CA
Other
Enumeration date
03/12/2018
Last updated
03/12/2018
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