Provider Demographics
NPI:1417930975
Name:GIANZERO, MARC V (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:V
Last Name:GIANZERO
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:PO BOX 1809
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-0809
Mailing Address - Country:US
Mailing Address - Phone:714-619-5387
Mailing Address - Fax:770-701-6662
Practice Address - Street 1:1640 NEWPORT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-478-8000
Practice Address - Fax:949-478-8001
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54882207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A548820Medicaid
CAWA62488CMedicare PIN
CAP00949439Medicare PIN
CAG96315Medicare UPIN
CA050070359Medicare PIN
CAA854882Medicare PIN
CAWA54882BMedicare PIN
CA00A548820Medicaid