Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 170563 | CA |
NPI | 1114453016 |
---|---|
Provider Name | Michael John Maranzano |
First Address | Los Angeles, CA 90095-3000 |
Second Address | Los Angeles, CA 90095-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 19/10/2020 |