Healthcare Provider Details

I. General information

NPI: 1750325098
Provider Name (Legal Business Name): MARLON FARLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W ALONDRA BLVD
COMPTON CA
90220-3500
US

IV. Provider business mailing address

3215 W IMPERIAL HWY
INGLEWOOD CA
90303-2810
US

V. Phone/Fax

Practice location:
  • Phone: 909-559-6233
  • Fax: 909-395-9880
Mailing address:
  • Phone: 909-559-6233
  • Fax: 909-395-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA61290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: