Healthcare Provider Details

I. General information

NPI: 1699983114
Provider Name (Legal Business Name): JAMES RICHARD MARRONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 10/21/2016

III. Provider practice location address

1468 N PINEBROOK AVE
UPLAND CA
91786-2680
US

IV. Provider business mailing address

1468 N PINEBROOK AVE
UPLAND CA
91786-2680
US

V. Phone/Fax

Practice location:
  • Phone: 909-204-2821
  • Fax: 909-204-2821
Mailing address:
  • Phone: 909-204-2821
  • Fax: 909-204-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA066870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: