Provider Demographics
NPI:1326275785
Name:P. MAROUNI, M.D INC.
Entity Type:Organization
Organization Name:P. MAROUNI, M.D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-430-1880
Mailing Address - Street 1:PO BOX 19211
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-9211
Mailing Address - Country:US
Mailing Address - Phone:818-430-1880
Mailing Address - Fax:
Practice Address - Street 1:13750 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2324
Practice Address - Country:US
Practice Address - Phone:818-430-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101224Medicare PIN