Basic Information
| Provider Information | |||||||||
| NPI: | 1912310863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARRON | ||||||||
| FirstName: | ANNETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 CASUDA CANYON DR | ||||||||
| Address2: | UNIT C | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917542238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235732676 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 E FOOTHILL BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269933000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.