Provider Demographics
NPI:1659300762
Name:TOMBOC, MARLAH MONTESCLAROS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLAH
Middle Name:MONTESCLAROS
Last Name:TOMBOC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32ND ST. BONIFACIO GLOBAL CITY
Mailing Address - Street 2:SUITE 731 MAB
Mailing Address - City:TAGUIG
Mailing Address - State:METRO MANILA
Mailing Address - Zip Code:1634
Mailing Address - Country:PH
Mailing Address - Phone:917-625-0927
Mailing Address - Fax:
Practice Address - Street 1:32ND ST. BONIFACIO GLOBAL CITY
Practice Address - Street 2:SUITE 731 MAB
Practice Address - City:TAGUIG
Practice Address - State:METRO MANILA
Practice Address - Zip Code:1634
Practice Address - Country:PH
Practice Address - Phone:917-625-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002002922080P0205X
NMMD2014-07172080P0205X
WI61000 - 202080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891302UMedicaid
NC2023361Medicare PIN
NC891302UMedicaid