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NPI Code Detail

MEDICARE: MARO ISSAC

MEDICARE: MARO ISSAC
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
1183500000XPharmacist83760CA

General Provider Information

NPI Number : 1316522881
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARO ISSAC
Provider Business Mailing Address
First Line : 12775 MILLENNIUM APT 309
Second Line :
City : PLAYA VISTA
State : CA
Zip : 90094-2970
Country : US
Telephone Number : 513-623-5513
Fax Number :
Provider Business Practice Location Address
First Line : 11795 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1211
Country : US
Telephone Number : 310-312-6506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2021
Last Update Date : 03/16/2021

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Directions to “ MARO ISSAC ” Practice Location

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