Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A067389 | CA |
Y | 213ES0000X | Sports Medicine | A067389 | CA |
NPI | 1194863514 |
---|---|
Provider Name | Dr. Evan Marlowe |
First Address | Valencia, CA 91355 |
Second Address | Sherman Oaks, CA 91403-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G95093 | (02) | CA |