Organization
CHRYSALIS HEALTH OF CALIFORNIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA TARASOVA (COO)
(847) 809-6796
Entity
Organization
Contact information
Practice address
4470 W SUNSET BLVD # 92709, LOS ANGELES, CA 90027-6302
(424) 334-9213
Mailing address
136 E 76TH ST APT 8F, NEW YORK, NY 10021-2831
(434) 248-7508
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104823954
—
CA
Enumeration date
11/08/2018
Last updated
01/22/2021
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