MEDICARE: GEORGE J MARACZI D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E3218	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000E32180	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1255438271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE J MARACZI D.P.M.

Provider Business Mailing Address
First Line	:	30001 TOWN CENTER DR STEE2
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2033
Country	:	US
Telephone Number	:	949-495-2506
Fax Number	:	949-495-3715

Provider Business Practice Location Address
First Line	:	30001 TOWN CENTER DR STEE2
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2033
Country	:	US
Telephone Number	:	949-495-2506
Fax Number	:	949-495-3715

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/07/2010

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Directions to “ GEORGE J MARACZI D.P.M.” Practice Location

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