Provider Demographics
NPI:1619126752
Name:ROBERTO H MARIANO MD
Entity Type:Organization
Organization Name:ROBERTO H MARIANO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-655-9902
Mailing Address - Street 1:12030 RIVERSIDE DR
Mailing Address - Street 2:SUITE # A
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3749
Mailing Address - Country:US
Mailing Address - Phone:818-655-9902
Mailing Address - Fax:
Practice Address - Street 1:12030 RIVERSIDE DR
Practice Address - Street 2:SUITE # A
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3749
Practice Address - Country:US
Practice Address - Phone:818-655-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73610261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center