Healthcare Provider Details

I. General information

NPI: 1013009778
Provider Name (Legal Business Name): MARVIN ERIC BELZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS# 2
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

5000 W SUNSET BLVD 4TH FLOOR
LOS ANGELES CA
90027-5861
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2153
  • Fax: 323-913-3691
Mailing address:
  • Phone: 323-361-3824
  • Fax: 323-953-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG61403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: