Provider Demographics
NPI:1972597607
Name:AMERIAN, MARYLEE (MD)
Entity type:Individual
Prefix:DR
First Name:MARYLEE
Middle Name:
Last Name:AMERIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2095
Mailing Address - Country:US
Mailing Address - Phone:310-829-9396
Mailing Address - Fax:310-829-3809
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-829-9396
Practice Address - Fax:310-829-3809
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54408207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54408Medicare ID - Type Unspecified
CAG54408AMedicare ID - Type Unspecified
CAE02753Medicare UPIN