Healthcare Provider Details

I. General information

NPI: 1528130333
Provider Name (Legal Business Name): MARLA R. ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLA UNDERLY

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27799 MEDICAL CENTER RD STE 440
MISSION VIEJO CA
92691-6400
US

IV. Provider business mailing address

27799 MEDICAL CENTER RD STE 440
MISSION VIEJO CA
92691-6400
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1007
  • Fax: 949-364-0317
Mailing address:
  • Phone: 949-364-1007
  • Fax: 949-364-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036106670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: