Provider Demographics
NPI:1568734655
Name:BERTRAND A. MARCANO, MD INC
Entity Type:Organization
Organization Name:BERTRAND A. MARCANO, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTRAND
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-261-0259
Mailing Address - Street 1:1700 CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE 3450
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-261-0259
Mailing Address - Fax:323-261-0073
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE 3450
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-261-0259
Practice Address - Fax:323-261-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22276282NC2000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No282NC2000XHospitalsGeneral Acute Care HospitalChildren