Healthcare Provider Details

I. General information

NPI: 1962447896
Provider Name (Legal Business Name): MARVIN AMENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 12-441 MDCC
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE 12-441 MDCC
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3952
  • Fax: 310-206-0209
Mailing address:
  • Phone: 310-206-3952
  • Fax: 310-206-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG11555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: