Provider Demographics
NPI:1194489690
Name:PIRES, MARLENE ANDRADE (NP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANDRADE
Last Name:PIRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-9268
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 1003
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4166
Practice Address - Country:US
Practice Address - Phone:310-423-9238
Practice Address - Fax:310-423-9777
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019000363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner