Healthcare Provider Details

I. General information

NPI: 1083883938
Provider Name (Legal Business Name): ROBERT MARRIOTT MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N PACIFIC COAST HWY STE 2175
EL SEGUNDO CA
90245-5639
US

IV. Provider business mailing address

222 N PACIFIC COAST HWY STE 2175
EL SEGUNDO CA
90245-5639
US

V. Phone/Fax

Practice location:
  • Phone: 877-878-3289
  • Fax: 877-817-3227
Mailing address:
  • Phone: 877-878-3289
  • Fax: 877-817-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA92018
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA92018
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT JAMES MARRIOTT
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 310-402-6811