Provider Demographics
NPI:1487779377
Name:MULAY, MARILYN (RN, NP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MULAY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 TEXAS AVE
Mailing Address - Street 2:UNIT 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1963
Mailing Address - Country:US
Mailing Address - Phone:310-571-0084
Mailing Address - Fax:
Practice Address - Street 1:PREMIERE ONCOLOGY
Practice Address - Street 2:2020 SANTA MONICA BLVD
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-633-8400
Practice Address - Fax:310-633-8419
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 496453163WX0200X
CANP 16738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0200XNursing Service ProvidersRegistered NurseOncology
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 16738OtherNURSE PRACTIONER LIC