Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 20A14057 | CA |
N | 207P00000X | Emergency Physician | 34.011750 | OH |
Y | 207P00000X | Emergency Physician | 5101019428 | MI |
N | 207P00000X | Emergency Physician | DO2371 | NV |
N | 207P00000X | Emergency Physician | R4592 | TX |
N | 207Q00000X | Family Doctor | 20A14057 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 20A14057 | CA |
NPI | 1659669018 |
---|---|
Provider Name | Dr. Michael Maruska |
First Address | Laguna Beach, CA 92651-2339 |
Second Address | Huntington Beach, CA 92647-6819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 20/04/2018 |