Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G61403 | CA |
NPI | 1013009778 |
---|---|
Provider Name | Marvin Eric Belzer |
First Address | Los Angeles, CA 90027-5861 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G14030 G10 | CAL OPTIMA (01) | CA |
00G614030 | (05) | CA |
E49066 | (02) | CA |