Healthcare Provider Details

I. General information

NPI: 1407550734
Provider Name (Legal Business Name): MARCO ALEXANDER CIANCIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26538 MOULTON PKWY STE 38E
LAGUNA HILLS CA
92653-8232
US

IV. Provider business mailing address

26538 MOULTON PKWY STE 38E
LAGUNA HILLS CA
92653-8232
US

V. Phone/Fax

Practice location:
  • Phone: 877-696-3622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA208449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: