Healthcare Provider Details

I. General information

NPI: 1255438149
Provider Name (Legal Business Name): BHARAT B MAROLIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD SUITE 473
HUNTINGTON BEACH CA
92647-7101
US

IV. Provider business mailing address

17822 BEACH BLVD SUITE 473
HUNTINGTON BEACH CA
92647-7101
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-6638
  • Fax: 714-369-8770
Mailing address:
  • Phone: 714-842-6638
  • Fax: 714-369-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA26762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: