Healthcare Provider Details

I. General information

NPI: 1861673998
Provider Name (Legal Business Name): MARCELO WILFRAN HINOJOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 22C
ORANGE CA
92868-3201
US

IV. Provider business mailing address

BOX 356410 1959 NE PACIFIC STREET
SEATTLE WA
98195-6410
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 206-221-7148
  • Fax: 206-543-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: