Provider Demographics
NPI:1508825258
Name:SANMARCO, MIGUEL EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:EDUARDO
Last Name:SANMARCO
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 1:3650 SOUTH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-633-4117
Mailing Address - Fax:562-633-6560
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-633-4117
Practice Address - Fax:562-633-6560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23825207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A238251Medicaid
CAA23709Medicare UPIN
CAA23825Medicare ID - Type Unspecified