MARSHAK MEDICAL GROUP INC NPI 1770604779

NPI Information

NPI: 1770604779
Provider Name: MARSHAK MEDICAL GROUP INC
Classification: Family Medicine - 207QA0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 05D0879103

Address:
3484 E 1ST ST
LOS ANGELES, CA
ZIP 90063
Phone: (323) 268-4436
Get Directions

MARSHAK MEDICAL GROUP INC is an adolescent medicine family medicine in Los Angeles, CA. The provider is a family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. MARSHAK MEDICAL GROUP INC NPI is 1770604779. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3484 E 1ST ST
LOS ANGELES, CA
ZIP 90063-946
Phone: (323) 268-4436
Fax: (323) 264-3049

The provider's authorized official is Herbert Marshak .
The authorized official title is M.d. and has the following contact phone number (323) 268-4436.

The CLIA number assigned to this NPI record is 05D0879103 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/3/2007 and was last updated on 7/14/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0000X	Family Medicine	Adolescent Medicine	A29118	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	W13627	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	INTERNAL MEDICINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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