Provider Demographics
NPI:1164447959
Name:MARZBAN, SIAMAK STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIAMAK
Middle Name:STEPHEN
Last Name:MARZBAN
Suffix:
Gender:M
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 1:2403 S MORAY AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4358
Mailing Address - Country:US
Mailing Address - Phone:310-832-2694
Mailing Address - Fax:310-547-0140
Practice Address - Street 1:2403 S MORAY AVE
Practice Address - Street 2:STE 2B
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4358
Practice Address - Country:US
Practice Address - Phone:310-832-2694
Practice Address - Fax:310-547-0140
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A482211Medicaid
CAF45641Medicare UPIN
CA00A482211Medicaid