MEDICARE: MR. DAVID LOREN MARCUS 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	2084P0800X	Psychiatry Physician	A78153	CA

General Provider Information

NPI Number	:	1437287208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID LOREN MARCUS M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 338
Second Line	:	10573 W. PICO BLVD
City	:	LOS ANGELES
State	:	CA
Zip	:	90064
Country	:	US
Telephone Number	:	424-402-9847
Fax Number	:	626-219-6658

Provider Business Practice Location Address
First Line	:	200 E ANAHEIM ST
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-4516
Country	:	US
Telephone Number	:	310-522-8700
Fax Number	:	310-549-8700

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	11/25/2019

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