Provider Demographics
NPI:1508837501
Name:ZAGULI, MARVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:J
Last Name:ZAGULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4800
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:9999 MIRA MESA BLVD
Practice Address - Street 2:102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1006
Practice Address - Country:US
Practice Address - Phone:858-566-4444
Practice Address - Fax:858-566-3321
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2011-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG38188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38188OtherMD LICENSE