Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G85332 | CA |
NPI | 1053389205 |
---|---|
Provider Name | Dr. Eric R Mariotti |
First Address | Concord, CA 94520-2084 |
Second Address | Concord, CA 94520-2084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 14/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G853320 | (05) | CA |
G73734 | (02) |