Donna Revae Mark

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

921 S Beacon St
San Pedro, CA 90731-3740

Phone

(310) 984-3055

Fax

(310) 984-3066

NPI assigned

Aug 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1871785782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S BEACON ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313740",
            "telephone_number": "310-984-3055",
            "fax_number": "310-984-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 S BEACON ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313740",
            "telephone_number": "310-984-3055",
            "fax_number": "310-984-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "DONNA",
        "middle_name": "REVAE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF BEHAVIORAL SERVICES",
            "identifier": "55577",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Elena Newcomer DDS Inc
• Marine Therapeutic
• Yvonne Marinkovich, D.C.
• Mark Perez , M.D.
• Mark Perez MD
• Lawrence Marshall, O.D.
• Daniel Martin
• David R Martin, D.D.S.
• Elmer Garnel Martin, DMD
• Jazmyne Martin

• Marriage & Family Therapist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.