Healthcare Provider Details

I. General information

NPI: 1659669018
Provider Name (Legal Business Name): MICHAEL MARUSKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17772 BEACH BLVD
HUNTINGTON BEACH CA
92647-6819
US

IV. Provider business mailing address

580 PARK AVE
LAGUNA BEACH CA
92651-2339
US

V. Phone/Fax

Practice location:
  • Phone: 714-843-5000
  • Fax:
Mailing address:
  • Phone: 714-366-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.011750
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO2371
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A14057
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4592
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14057
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A14057
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101019428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: