Provider Demographics
NPI:1679673776
Name:MARIANAYAGAM, S JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:S JOSEPH
Middle Name:
Last Name:MARIANAYAGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 WEST AVENUE J
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-948-0012
Mailing Address - Fax:661-940-0206
Practice Address - Street 1:1331 WEST AVENUE J
Practice Address - Street 2:SUITE 203
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-948-0012
Practice Address - Fax:661-940-0206
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B50515Medicare UPIN
CAA43915Medicare ID - Type Unspecified