MEDICARE: CHRIS MARASCO, M.D., INC.

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	207R00000X	Internal Medicine Physician	G46383	CA

General Provider Information

NPI Number	:	1760430680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS MARASCO, M.D., INC.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1080
Fax Number	:	818-528-1255

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1080
Fax Number	:	818-528-1255

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRIS M. MARASCO
Credential	:	M.D,
Telephone Number	:	818-528-1080

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/14/2010

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