| 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 |