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General NPI Number Information
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NPI Number | 1881940427
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Entity Type | Organization
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Legal Business Name | MARILYN S. KWOLEK MD, PC
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 917 SAN RAMON VALLEY BLVD STE 199
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City | DANVILLE
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State | CA
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Zip | 94526-4032
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Country | US
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Telephone | 925-838-2677
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Fax | 925-838-6924
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Provider Business Mailing Address
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Address Line | 917 SAN RAMON VALLEY BLVD STE 199
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City | DANVILLE
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State | CA
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Zip | 94526-4032
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Country | US
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Telephone | 925-838-2677
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Fax | 925-838-6924
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARILYN S. KWOLEK
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Credential | MD
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Telephone | 925-838-2677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C41932
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License Number State | CA
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