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General NPI Number Information
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NPI Number | 1336505197
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Entity Type | Organization
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Legal Business Name | LEGACY MARKETING WORLDWIDE INC.
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 5015 EAGLE ROCK BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90041-2087
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Country | US
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Telephone | 747-300-7541
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Fax | 818-471-4287
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Provider Business Mailing Address
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Address Line | 5015 EAGLE ROCK BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90041-2087
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Country | US
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Telephone | 747-300-7541
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Fax | 818-471-4287
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARLON C SALAMAT
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Credential | ADMINISTRATOR
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Telephone | 747-300-7541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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