Provider Demographics
NPI:1518922178
Name:WARLEN, MARK EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVAN
Last Name:WARLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3720 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4112
Mailing Address - Country:US
Mailing Address - Phone:619-298-7221
Mailing Address - Fax:619-298-8609
Practice Address - Street 1:3720 THIRD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4112
Practice Address - Country:US
Practice Address - Phone:619-298-7221
Practice Address - Fax:619-298-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8390034Medicaid
F77170Medicare UPIN
4111910001Medicare NSC
CA8390034Medicaid