Provider Demographics
NPI:1558460220
Name:MARRALLE, TONIA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:MARIE
Last Name:MARRALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 HOSPITAL RD STE 424
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3525
Mailing Address - Country:US
Mailing Address - Phone:949-645-5885
Mailing Address - Fax:949-645-0234
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:SUITE 424
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-645-5885
Practice Address - Fax:949-645-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23299Medicare UPIN