MEDICARE: DR. MARILYN ALA-AN ACIRO 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	207Q00000X	Family Medicine Physician	A36352	CA

General Provider Information

NPI Number	:	1700142650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN ALA-AN ACIRO M.D.

Provider Business Mailing Address
First Line	:	4085 HAWK ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1831
Country	:	US
Telephone Number	:	619-299-4330
Fax Number	:	619-475-6204

Provider Business Practice Location Address
First Line	:	502 EUCLID AVE STE 201
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2949
Country	:	US
Telephone Number	:	619-475-6204
Fax Number	:	619-475-5174

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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