=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427989797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTO NINO MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2026
-----------------------------------------------------
Last Update Date | 05/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14860 ROSCOE BLVD STE 201
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-206-3380
-----------------------------------------------------
Fax | 818-206-3390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 15655
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90209-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-206-3380
-----------------------------------------------------
Fax | 818-206-3390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GLENN A MARSHAK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-553-5203
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------