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NPI Code Detail

MEDICARE: ROBERT MARRIOTT MEDICAL CORP

MEDICARE: ROBERT MARRIOTT MEDICAL CORP
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
1208600000XSurgery Physician

Other Identifiers

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

General Provider Information

NPI Number : 1164973012
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT MARRIOTT MEDICAL CORP
Provider Business Mailing Address
First Line : 222 N PACIFIC COAST HWY STE 2175
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5639
Country : US
Telephone Number : 877-878-3289
Fax Number : 877-817-3227
Provider Business Practice Location Address
First Line : 711 MATADOR LN
Second Line :
City : MESQUITE
State : TX
Zip : 75149-8830
Country : US
Telephone Number : 877-878-3289
Fax Number : 877-817-3227
Authorized Official
Title or Position : CEO
Name : ROBERT J MARRIOTT
Credential : MD
Telephone Number : 877-878-3289
Provider Enumeration Date : 10/16/2016
Last Update Date : 11/08/2018

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