Provider Demographics
NPI:1003916701
Name:CONANAN, MARLYN CERVANIA (MD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:CERVANIA
Last Name:CONANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N 1ST ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6800
Mailing Address - Country:US
Mailing Address - Phone:559-222-5900
Mailing Address - Fax:559-222-0029
Practice Address - Street 1:3636 N 1ST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-222-5900
Practice Address - Fax:559-222-0029
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A714960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A714960OtherMEDICAL BOARD