Provider Demographics
NPI:1053704551
Name:KROM, MARISA (NP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:KROM
Suffix:
Gender:
Credentials:NP-BC
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:WINTHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:BOX 468
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:424-306-7610
Mailing Address - Fax:310-212-0334
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:BOX 468
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-4168
Practice Address - Fax:310-222-4006
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001469363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics