Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G64377 | CA |
NPI | 1013974393 |
---|---|
Provider Name | Michael S Marandola |
First Address | Mission Viejo, CA 92691-6302 |
Second Address | Mission Viejo, CA 92691-6302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM1658092 | DEA (01) | CA |
F11702 | (02) | CA |