Healthcare Provider Details

I. General information

NPI: 1427989797
Provider Name (Legal Business Name): SANTO NINO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14860 ROSCOE BLVD STE 201
PANORAMA CITY CA
91402-4689
US

IV. Provider business mailing address

PO BOX 15655
BEVERLY HILLS CA
90209-1655
US

V. Phone/Fax

Practice location:
  • Phone: 818-206-3380
  • Fax: 818-206-3390
Mailing address:
  • Phone: 818-206-3380
  • Fax: 818-206-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN A MARSHAK
Title or Position: OWNER
Credential: M.D.
Phone: 310-553-5203