MEDICARE: DR. MARA COLOMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A45090	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023184132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARA COLOMA MD

Provider Business Mailing Address
First Line	:	PO BOX 10432
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-3432
Country	:	US
Telephone Number	:	213-637-2530
Fax Number	:	213-384-3373

Provider Business Practice Location Address
First Line	:	6347 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4101
Country	:	US
Telephone Number	:	323-583-8383
Fax Number	:	323-583-8399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/14/2010

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