Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | C164730 | CA |
NPI | 1093363848 |
---|---|
Provider Name | Anthony Martin Ocana |
First Address | Marina Del Rey, CA 90292-6018 |
Second Address | Marina Del Rey, CA 90292-6018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 05/02/2021 |