MEDICARE: MARC V. GIANZERO M.D.

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	207L00000X	Anesthesiology Physician	A54882	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	:	1417930975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC V. GIANZERO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1809
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92856-0809
Country	:	US
Telephone Number	:	714-619-5387
Fax Number	:	770-701-6662

Provider Business Practice Location Address
First Line	:	1640 NEWPORT BLVD STE 100
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3786
Country	:	US
Telephone Number	:	949-478-8000
Fax Number	:	949-478-8001

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/14/2019

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