ROBERT J MARRIOTT MEDICAL CORP (NPI# 1245667013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245667013 |
| Entity Type | Organization |
| Organization Name | ROBERT J MARRIOTT MEDICAL CORP |
| Practice Address |
5475 E La Palma Ave Suite 204 Anaheim CA 92807-2075 |
| Mailing Address |
222 N Sepulveda Blvd Suite 2175 El Segundo CA 90245-5639 |
| Practice Telephone | 3105241320 |
| Practice Fax Number | 3107064212 |
| Mailing Telephone | 3105241320 |
| Mailing Fax Number | 3107064212 |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2015-02-24 |
| Authorized Official Name | ROBERT J MARRIOTT (CEO) |
| Authorized Official Telephone | 3105241320 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
5475 E LA PALMA AVE SUITE 204 |
| City | ANAHEIM |
| State | CA |
| Zip Code | 92807-2075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922027218 | Edwin Samuel Kulubya | Anesthesiology | 5475 E La Palma Ave, Suite 202, Anaheim, CA 92807-2075 | 2006-07-18 |
| 1467072132 | Adam Brasket | Registered Nurse | 5475 E La Palma Ave, Anaheim, CA 92807-2075 | 2020-04-22 |
| 1376926808 | James C. Lee, Dpm A Professional Corp | Podiatrist | 5475 E La Palma Ave, Suite 208, Anaheim, CA 92807-2075 | 2015-07-01 |
| 1962800318 | West Regional Cardiothoracic & Vascular Surgeons W R Vein Center | Surgery | 5475 E La Palma Ave, Suite 204, Anaheim, CA 92807-2075 | 2014-12-17 |
| 1063823391 | Silvia Song | Dermatology | 5475 E La Palma Ave, Anaheim, CA 92807-2075 | 2014-05-08 |
| 1528327327 | Jaryd Freedman | Dermatology | 5475 E La Palma Ave, Suite 201, Anaheim, CA 92807-2075 | 2012-05-14 |
| 1205141074 | Edan M Devora | Physical Therapist | 5475 E La Palma Ave, 200, Anaheim, CA 92807-2075 | 2010-08-17 |
| 1538480959 | Artisan Foot and Ankle Specialist | Podiatrist | 5475 E La Palma Ave, Ste 208, Anaheim, CA 92807-2075 | 2010-06-21 |
| 1548490568 | Sherry Youssef | Dermatology | 5475 E La Palma Ave, Suite 201, Anaheim, CA 92807-2075 | 2009-07-24 |
| 1831327121 | Van Tl Hoang | Dermatology | 5475 E La Palma Ave, Suite 201, Anaheim, CA 92807-2075 | 2009-06-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801400759 | Katie Greasby | Marriage & Family Therapist | 509 S. Villa Real Dr. #117, Anaheim Hills, CA 92807 | 2020-09-08 |
| 1386201481 | Joseph Hasrouni | Counselor | Cvs 9753, 5735 E. La Palma Ave, Anaheim, CA 92807 | 2019-05-23 |
| 1144739277 | Luis Antonio Perez | Social Worker | 2112 E 4th St. #107, Santa Ana, CA 92807 | 2017-09-20 |
| 1548781883 | F.foroutan Dds Inc. | Dentist | 5031 E. Orangethorpe Ave., Suite # B-2, Anaheim Hills, CA 92807 | 2017-06-27 |
| 1487101515 | Eloy Ramirez | Counselor | 233 S. Quintana Drive, Anaheim, CA 92807 | 2016-09-07 |
| 1255786448 | K's Loving Care | Custodial Care Facility | 1211 N Amelia St, Anaheim, CA 92807 | 2016-04-26 |
| 1265806673 | Jessica Vickers | Marriage & Family Therapist | 5500 E Santa Ana Canyon Rd Ste 216, Anaheim, CA 92807 | 2015-11-23 |
| 1033596796 | Donovan Garcia Teves | Specialist | 1261 Lakeview Ave., Suite 'a', Anaheim Hills, CA 92807 | 2015-05-01 |
| 1235544354 | Nicole Reaves | Occupational Therapist | 5630 E Santa Ana Canyon Rd Ste 105, Anaheim, CA 92807 | 2014-06-26 |
| 1093143471 | Behrang E Toubak | Counselor | 6381 E Via Arboles, Anaheim, CA 92807 | 2013-10-23 |
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| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952481160 | Stephen Michael Kubaska IIi | Surgery | 1211 W. La Palma Avenue, Suite 505, Anaheim, CA 92801-2812 | 2006-10-16 |
| 1346309937 | Kyu Oh | Surgery | 441 N Lakeview Ave, Anaheim, CA 92807-3028 | 2006-12-08 |
| 1063583037 | Sidney M. Glazer | Surgery | 441 N Lakeview Ave, Anaheim, CA 92807-3028 | 2006-11-13 |
| 1437220324 | Peter Sae Oh Paik | Surgery | 441 N Lakeview Ave, Anaheim, CA 92807-3028 | 2006-11-13 |
| 1316018203 | Michael M. Farooq | Surgery | 441 N Lakeview Ave, Anaheim, CA 92807-3028 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
| 1992341895 | Surgicalist of Ca PC | Surgery | 3300 E South St Ste 301a, Lakewood, CA 90805-4549 | 2019-11-26 |
| 1528600558 | Kevin M Casey Md Apmc | Surgery | 1919 State St # 204-206, Santa Barbara, CA 93101-2430 | 2019-10-10 |
| 1487117594 | John Nastasi | Surgery | 100 W Valencia Mesa Dr # 211, Fullerton, CA 92835-3768 | 2019-04-08 |
| 1225508385 | Jay Labourene | Surgery | 1550 G Tiburon Blvd, Tiburon, CA 94920-2531 | 2018-12-03 |
| 1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
| 1437638517 | Thousand Oaks Vein Clinic PC | Surgery | 225 N Moorpark Rd Ste C, Thousand Oaks, CA 91360-4320 | 2018-08-09 |
| 1881186377 | Lavs Access Center Inc. | Surgery | 620 W Beverly Blvd Ste B, Montebello, CA 90640-3624 | 2018-05-31 |
| 1841789328 | Sunil Rayan, M.d., Inc. | Surgery | 320 Santa Fe Dr Ste 212, Encinitas, CA 92024-5139 | 2018-05-09 |
| 1245739820 | Northridge Vascular Center A Professional Medical Corporation | Surgery | 19331 Business Center Dr Ste 102, Northridge, CA 91324-3533 | 2018-02-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.