MEDICARE: ORRY J MARCIANO II PA

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	363A00000X	Physician Assistant	PA17886	CA

General Provider Information

NPI Number	:	1194808519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORRY J MARCIANO II PA

Provider Business Mailing Address
First Line	:	5030 CAMINO DE LA SIESTA
Second Line	:	#208
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3117
Country	:	US
Telephone Number	:	858-373-2444
Fax Number	:	619-260-6307

Provider Business Practice Location Address
First Line	:	5030 CAMINO DE LA SIESTA
Second Line	:	#208
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3117
Country	:	US
Telephone Number	:	858-373-2444
Fax Number	:	619-260-6307

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

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	07/08/2007

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