Provider Demographics
NPI:1043583107
Name:MARIANITO D SEVILLA MD INC APC
Entity Type:Organization
Organization Name:MARIANITO D SEVILLA MD INC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANITO
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-470-7007
Mailing Address - Street 1:2340 E 8TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2869
Mailing Address - Country:US
Mailing Address - Phone:619-470-7007
Mailing Address - Fax:619-470-9379
Practice Address - Street 1:2340 E 8TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2869
Practice Address - Country:US
Practice Address - Phone:619-470-7007
Practice Address - Fax:619-470-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty