Healthcare Provider Details

I. General information

NPI: 1073951109
Provider Name (Legal Business Name): MARJON VATANCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6865 ALTON PKWY STE 210
IRVINE CA
92618-3741
US

IV. Provider business mailing address

6865 ALTON PKWY STE 210
IRVINE CA
92618-3741
US

V. Phone/Fax

Practice location:
  • Phone: 949-800-8551
  • Fax: 949-800-8090
Mailing address:
  • Phone: 949-800-8551
  • Fax: 949-800-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD16800
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA-155824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: