Healthcare Provider Details

I. General information

NPI: 1194926592
Provider Name (Legal Business Name): MARIAN JALIL M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 WHITTIER BLVD STE 200
WHITTIER CA
90605-2148
US

IV. Provider business mailing address

14350 WHITTIER BLVD STE 200
WHITTIER CA
90605-2148
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-7671
  • Fax: 562-945-7485
Mailing address:
  • Phone: 562-945-7671
  • Fax: 562-945-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberW10442
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW10442
License Number StateCA

VIII. Authorized Official

Name: MARIAN JALIL
Title or Position: OWNER
Credential: M D INC
Phone: 562-945-7671