Provider Demographics
NPI:1508806027
Name:MARCOS, WADIE L (DO)
Entity Type:Individual
Prefix:DR
First Name:WADIE
Middle Name:L
Last Name:MARCOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E PCH
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2013
Mailing Address - Country:US
Mailing Address - Phone:800-780-1230
Mailing Address - Fax:
Practice Address - Street 1:3900 E PCH
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2013
Practice Address - Country:US
Practice Address - Phone:800-780-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8922207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX89220Medicaid
CA020A89220Medicare ID - Type UnspecifiedMEDICARE
CA00AX89220Medicaid