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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 496453163WX0200X
CANP 16738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 16738OtherNURSE PRACTIONER LIC