Healthcare Provider Details

I. General information

NPI: 1275386914
Provider Name (Legal Business Name): MAROM MARONG MAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ROSE DR
PLACENTIA CA
92870-3802
US

IV. Provider business mailing address

2753 PINE CREEK CIR
FULLERTON CA
92835-2938
US

V. Phone/Fax

Practice location:
  • Phone: 714-993-2000
  • Fax:
Mailing address:
  • Phone: 562-682-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95261562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: