Active NPI
Marie Eyssallenne
- Medical Physician Assistant
- Los Angeles, CA
National Provider Identifier
1821281411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA11819
- Practice address
- 1640 Marengo St
300
Los Angeles, CA 90033-1036 - Phone
- (323) 226-2200
- NPI assigned
- Aug 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA11819 | CA | Primary |
Addresses
Primary practice location
1640 Marengo St
300
Los Angeles, CA 90033-1036
Mailing address
1640 Marengo St
300
Los Angeles, CA 90033-1036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130904000514 | CA | Order and Referring Only - Physician Assistant | 7012150493 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188172800000",
"number": "1821281411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 MARENGO ST",
"address_2": "300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 MARENGO ST",
"address_2": "300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331036",
"telephone_number": "323-226-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EYSSALLENNE",
"first_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-27",
"last_updated": "2007-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA11819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.