Provider Demographics
NPI:1578959185
Name:MARK C. ADRIAN INC.
Entity Type:Organization
Organization Name:MARK C. ADRIAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-202-0011
Mailing Address - Street 1:9850 GENESEE AVE STE 355
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1227
Mailing Address - Country:US
Mailing Address - Phone:858-202-0011
Mailing Address - Fax:858-202-0055
Practice Address - Street 1:9850 GENESEE AVE STE 355
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1227
Practice Address - Country:US
Practice Address - Phone:858-202-0011
Practice Address - Fax:858-202-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK C. ADRIAN INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G788950Medicaid
CAG32882Medicare UPIN
CA00G788950Medicare PIN