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General NPI Number Information
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NPI Number | 1982619672
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Entity Type | Organization
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Legal Business Name | MANISH B. MAROLIA, M.D., INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE STE 380
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-596-5557
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Fax | 714-486-1604
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE STE 380
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-596-5557
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Fax | 714-486-1604
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Authorized Official
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Title or Position | M.D./ CEO
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Name | DR. MANISH B MAROLIA
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Credential | M.D.
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Telephone | 714-596-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A67462
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A67462
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License Number State | CA
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