Healthcare Provider Details

I. General information

NPI: 1831167857
Provider Name (Legal Business Name): MARC A TAMAROFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE SUITE 209
LONG BEACH CA
90808-2147
US

IV. Provider business mailing address

3816 WOODRUFF AVE SUITE 209
LONG BEACH CA
90808-2145
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-4749
  • Fax: 562-429-3329
Mailing address:
  • Phone: 562-496-4749
  • Fax: 562-429-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA84131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: