Marylou Aclan, | |
14400 Olive View Dr, Sylmar, CA 91342-1436 | |
(747) 210-4324 | |
Not Available |
Full Name | Marylou Aclan |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 14400 Olive View Dr, Sylmar, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1881162147 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 95010201 (California) | Secondary |
363LF0000X | Nurse Practitioner - Family | 95010201 (California) | Primary |
Entity Name | County Of Los Angeles |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1851363188 PECOS PAC ID: 1850296534 Enrollment ID: O20031204001218 |
Entity Name | Northeast Valley Health Corporation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1629079009 PECOS PAC ID: 3173517323 Enrollment ID: O20040412001067 |
Entity Name | Mobile Medical Group Inc. |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1487169660 PECOS PAC ID: 8224397963 Enrollment ID: O20180125002042 |
Entity Name | Shine Mmg Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1053930248 PECOS PAC ID: 6103257282 Enrollment ID: O20200505000514 |
Entity Name | California Mobile Medical Group Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1588439061 PECOS PAC ID: 7719330091 Enrollment ID: O20240202001837 |
Mailing Address | Practice Location Address |
---|---|
Marylou Aclan, 27074 Hidaway Ave Unit 6, Canyon Country, CA 91351-4121 Ph: (818) 731-1657 | Marylou Aclan, 14400 Olive View Dr, Sylmar, CA 91342-1436 Ph: (747) 210-4324 |