Provider Demographics
NPI:1639857394
Name:MARCHMAN, TRAVIS ALEXANDER
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ALEXANDER
Last Name:MARCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 S COAST DR STE 225
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7757
Mailing Address - Country:US
Mailing Address - Phone:949-743-1457
Mailing Address - Fax:949-274-8299
Practice Address - Street 1:940 S COAST DR STE 225
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7757
Practice Address - Country:US
Practice Address - Phone:949-743-1457
Practice Address - Fax:949-274-8299
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program