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General NPI Number Information
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NPI Number | 1245667013
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Entity Type | Organization
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Legal Business Name | ROBERT J MARRIOTT MEDICAL CORP
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 5475 E LA PALMA AVE SUITE 204
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City | ANAHEIM
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State | CA
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Zip | 92807-2075
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Country | US
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Telephone | 310-524-1320
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Fax | 310-706-4212
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Provider Business Mailing Address
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Address Line | 222 N SEPULVEDA BLVD SUITE 2175
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5639
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Country | US
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Telephone | 310-524-1320
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Fax | 310-706-4212
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Authorized Official
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Title or Position | CEO
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Name | ROBERT J MARRIOTT
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Credential | MD
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Telephone | 310-524-1320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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