Healthcare Provider Details

I. General information

NPI: 1841535192
Provider Name (Legal Business Name): MARC J. METH, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST STE. 810
LOS ANGELES CA
90067-2011
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 810
LOS ANGELES CA
90067-2011
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-1377
  • Fax: 310-556-1650
Mailing address:
  • Phone: 310-556-1377
  • Fax: 310-556-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberA103999
License Number StateCA

VIII. Authorized Official

Name: MARC J. METH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-556-1377