Healthcare Provider Details

I. General information

NPI: 1306901087
Provider Name (Legal Business Name): MARSHA ANNE HATEM GERRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARSHA ANNE HATEM M.D.

II. Dates (important events)

Enumeration Date: 12/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S GLENOAKS BLVD SUITE 3
BURBANK CA
91502-1319
US

IV. Provider business mailing address

303 S GLENOAKS BLVD SUITE 3
BURBANK CA
91502-1319
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-5555
  • Fax: 818-842-0355
Mailing address:
  • Phone: 818-842-5555
  • Fax: 818-842-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG43078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: