| Gustavo Marks, Md Inc | |
|
22030 Sherman Way #318 Canoga Park CA 91303-1886 | |
| (818) 999-5900 | |
| (818) 999-5901 |
| Full Name | Gustavo Marks, Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 22030 Sherman Way #318, Canoga Park, California |
| Authorized Official Name and Position | Gustavo Marks (OWNER) |
| Authorized Official Contact | 8189995900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gustavo Marks, Md Inc Po Box 27206 Los Angeles CA 90027-0206 Ph: (213) 385-0675 | Gustavo Marks, Md Inc 22030 Sherman Way #318 Canoga Park CA 91303-1886 Ph: (818) 999-5900 |
| NPI Number | 1164770228 |
|---|---|
| Provider Enumeration Date | 08/21/2012 |
| Last Update Date | 08/21/2012 |
| Medicare PECOS PAC ID | 8921250911 |
|---|---|
| Medicare Enrollment ID | O20121221000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164770228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A54483 (California) | Primary |
| Provider Name | Gustavo J Marks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740373315 PECOS PAC ID: 2062408305 Enrollment ID: I20040422000811 |
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