Healthcare Provider Details

I. General information

NPI: 1639485543
Provider Name (Legal Business Name): MARILYN G. MYERS, M.D., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E FRUIT ST STE 217
SANTA ANA CA
92701-4459
US

IV. Provider business mailing address

2220 E FRUIT ST STE 217
SANTA ANA CA
92701-4459
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-3393
  • Fax: 714-541-8830
Mailing address:
  • Phone: 714-541-3393
  • Fax: 714-541-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC23521
License Number StateCA

VIII. Authorized Official

Name: DR. MARILYN G MYERS
Title or Position: OWNER
Credential: M.D.
Phone: 714-541-3393