MEDICARE: MARLA M GANDARA 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	207P00000X	Emergency Medicine Physician	A115486	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	A115486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A115486	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1902108145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA M GANDARA M.D.

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-423-9520
Fax Number	:	310-423-9525

Provider Business Practice Location Address
First Line	:	501 S BUENA VISTA ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4809
Country	:	US
Telephone Number	:	818-847-4055
Fax Number	:	818-848-4320

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	04/22/2024

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Directions to “ MARLA M GANDARA M.D.” Practice Location

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