Marilyn Tadiaman Pudol

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95008725 Issued in CA

Practice address

2101 Rosecrans Ave # 3230
El Segundo, CA 90245-4749

Phone

(323) 628-8671

NPI assigned

Jun 25, 2018

Last updated

Oct 24, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: mpudol@landmarkhealth-direct.org
• Direct secure messaging: somatusincmra.marilynpudol@157985.advancedmd-direct.com
• Direct secure messaging: somatusmedicalgroup.marilynpudol@157982.advancedmd-direct.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1720573439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3056 FLETCHER DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900652207",
            "telephone_number": "323-256-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ROSECRANS AVE # 3230",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454749",
            "telephone_number": "323-628-8671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3056 Fletcher Dr",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900652207",
            "country_code": "US",
            "telephone_number": "323-256-2231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUDOL",
        "first_name": "MARILYN",
        "middle_name": "TADIAMAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95008725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aidan Prince
• Sierra Principal
• Kaylynn Pritchard
• Rosalie Pruccoli
• Stacy Puc
• Nayeli Puente
• Elyza Puerto
• Marcos Puga
• G'Onna Pugh
• Lindsay Michal Pugh, M.S., CCC-SLP

• Family Nurse Practitioner in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.