Provider Demographics
NPI:1104353937
Name:CHANG, MARLEE (ARNP)
Entity type:Individual
Prefix:
First Name:MARLEE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21515 HAWTHORNE BLVD STE G100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6501
Mailing Address - Country:US
Mailing Address - Phone:424-571-2618
Mailing Address - Fax:424-571-2339
Practice Address - Street 1:5085 W PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2000
Practice Address - Country:US
Practice Address - Phone:972-665-8484
Practice Address - Fax:469-409-4557
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9321237363LP0200X
MARN2375770363LP0200X
CA95025203363LP0200X
TX1106612363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics