Healthcare Provider Details

I. General information

NPI: 1780066613
Provider Name (Legal Business Name): MARLYS R DRANGE, MD,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE SUITE 105
PASADENA CA
91105-2561
US

IV. Provider business mailing address

301 S FAIR OAKS AVE SUITE 105
PASADENA CA
91105-2561
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-2663
  • Fax: 626-795-2012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA54654
License Number StateCA

VIII. Authorized Official

Name: MARLYS R DRANGE
Title or Position: OWNER
Credential: MD
Phone: 626-795-2663