Provider Demographics
NPI:1619242153
Name:TONIA MARIE MARRALLE, M.D., INC
Entity Type:Organization
Organization Name:TONIA MARIE MARRALLE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARRALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-5885
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:424
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
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 2:424
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22908282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22908Medicare PIN