Provider Demographics
NPI:1679844880
Name:MARIALYN J SARDO, M.D, INC.
Entity Type:Organization
Organization Name:MARIALYN J SARDO, M.D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIALYN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-6226
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:410
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-452-6226
Mailing Address - Fax:858-452-6235
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:410
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-452-6226
Practice Address - Fax:858-452-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51066208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty