Provider Demographics
NPI:1164414603
Name:MARCHIOLI, LOUIS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:EDWARD
Last Name:MARCHIOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1301
Mailing Address - Country:US
Mailing Address - Phone:562-902-1014
Mailing Address - Fax:562-902-1015
Practice Address - Street 1:15040 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1301
Practice Address - Country:US
Practice Address - Phone:562-902-1014
Practice Address - Fax:562-902-1015
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2017-03-07
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAC35395207KA0200X, 207RA0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953063755OtherTAX ID #
CA953063755OtherTAX ID #
CAA87796Medicare UPIN
CAWC35395AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #