Marissa Chantorn
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Manhattan Beach, CA
NPI 1831883008 · NPPES record last updated Jun 8, 2023
Key facts
- NPI
- 1831883008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 95329832 (CA)
- Practice address
- 1101 N Sepulveda Blvd Ste 201
Manhattan Beach, CA 90266-5963 - Phone
- (877) 859-2341
- NPI assigned
- Jun 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95329832 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neuro Wellness Spa, a Medical PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95329832 | CA | Yes |
Addresses
Primary practice location
1101 N Sepulveda Blvd Ste 201
Manhattan Beach, CA 90266-5963
Mailing address
2935 Lorain Rd
San Marino, CA 91108-2734
Other providers in Manhattan Beach, CA
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- Jose L Cervantes
- Chan Diep OD Inc
- Elizabeth Chang
- Jonah Chang
- Brian Chao
- Girija Charugundla
- Claudia Grande Chavez
- Hiuching Cheung
- Michelle Chin
All providers in Manhattan Beach, CA · Psychiatric/Mental Health Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.