Provider Demographics
NPI:1386745909
Name:FAYMAN, MARIANA (PA-C, RN)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:FAYMAN
Suffix:
Gender:F
Credentials:PA-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3153
Mailing Address - Country:US
Mailing Address - Phone:310-248-8200
Mailing Address - Fax:310-248-8290
Practice Address - Street 1:8536 WILSHIRE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-248-8200
Practice Address - Fax:310-248-8290
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-286363A00000X
CAPA20571363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20571OtherPA20571
ARR77689OtherARKANSAS RN LICENSE NUMBE