Provider Demographics
NPI:1609269885
Name:A. MARSH MEDICAL CLINIC
Entity Type:Organization
Organization Name:A. MARSH MEDICAL CLINIC
Other - Org Name:CLINICA VIRGEN GUADALUPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-604-9591
Mailing Address - Street 1:615 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3211
Mailing Address - Country:US
Mailing Address - Phone:323-604-9591
Mailing Address - Fax:323-604-9594
Practice Address - Street 1:615 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3211
Practice Address - Country:US
Practice Address - Phone:323-604-9591
Practice Address - Fax:323-604-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22547207R00000X, 207RH0000X, 207RH0003X
CAPA15732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C225470Medicaid
CAC22547Medicare UPIN
CAA32198Medicare UPIN