Basic Information
| Provider Information | |||||||||
| NPI: | 1194213678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARRIOTT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 NORTHVIEW CIR | ||||||||
| Address2: | |||||||||
| City: | YREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960972139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606326952 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 444 BRUCE ST | ||||||||
| Address2: | |||||||||
| City: | YREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960973450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308424121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 0101271644 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080P0204X | 0101271644 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 0101271644 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A180921 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.