Provider Demographics
NPI:1336505197
Name:LEGACY MARKETING WORLDWIDE INC.
Entity Type:Organization
Organization Name:LEGACY MARKETING WORLDWIDE INC.
Other - Org Name:PERPETUAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:747-300-7541
Mailing Address - Street 1:5015 EAGLE ROCK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2087
Mailing Address - Country:US
Mailing Address - Phone:747-300-7541
Mailing Address - Fax:818-471-4287
Practice Address - Street 1:5015 EAGLE ROCK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2087
Practice Address - Country:US
Practice Address - Phone:747-300-7541
Practice Address - Fax:818-471-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care