Healthcare Provider Details

I. General information

NPI: 1639171788
Provider Name (Legal Business Name): CALVIN MARANTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

PO BOX 3553
MISSION VIEJO CA
92690-1553
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-6383
  • Fax: 951-736-6384
Mailing address:
  • Phone: 949-347-8441
  • Fax: 949-347-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberG12076
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG12076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: