Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A122167 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A122167 | CA |
NPI | 1063727907 |
---|---|
Provider Name | Dr. Douglas Dizon Marania |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 22/02/2016 |