Healthcare Provider Details

I. General information

NPI: 1295122653
Provider Name (Legal Business Name): MARLON MARAGAY MADUCDOC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 300
DOWNEY CA
90241-5023
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE STE 300
DOWNEY CA
90241-5023
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 562-904-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA145398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: