MEDICARE: DR. MARC R AVENT DO

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	207Q00000X	Family Medicine Physician	20A9174	CA
2	207R00000X	Internal Medicine Physician	20A9174	CA

General Provider Information

NPI Number	:	1437104783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC R AVENT DO

Provider Business Mailing Address
First Line	:	7777 MILLIKEN AVE
Second Line	:	STE 220
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-6780
Country	:	US
Telephone Number	:	909-484-4234
Fax Number	:	909-484-4235

Provider Business Practice Location Address
First Line	:	7777 MILLIKEN AVE
Second Line	:	STE 220
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-6780
Country	:	US
Telephone Number	:	909-484-4234
Fax Number	:	909-484-4235

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	04/20/2011

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Directions to “ DR. MARC R AVENT DO” Practice Location

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