Healthcare Provider Details

I. General information

NPI: 1871866715
Provider Name (Legal Business Name): ALFRED C. MARRONE, MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23441 MADISON ST STE 120
TORRANCE CA
90505
US

IV. Provider business mailing address

420 E 3RD ST STE 603
LOS ANGELES CA
90013-1645
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-0300
  • Fax: 310-530-2367
Mailing address:
  • Phone: 213-625-2694
  • Fax: 213-680-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG24447
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG24447
License Number StateCA

VIII. Authorized Official

Name: ALFRED C MARRONE
Title or Position: OWNER
Credential: MD
Phone: 310-530-0300