Provider Demographics
NPI:1326071481
Name:MATAR, MARLA MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:MARINA
Last Name:MATAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17620 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6608
Mailing Address - Country:US
Mailing Address - Phone:626-824-6747
Mailing Address - Fax:
Practice Address - Street 1:17620 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-6608
Practice Address - Country:US
Practice Address - Phone:626-824-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26384207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology