Provider Demographics
NPI:1750325098
Name:FARLEY, MARLON (MD)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:FARLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2810
Mailing Address - Country:US
Mailing Address - Phone:909-559-6233
Mailing Address - Fax:909-395-9880
Practice Address - Street 1:818 W ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3500
Practice Address - Country:US
Practice Address - Phone:909-559-6233
Practice Address - Fax:909-395-9880
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61290173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A612902Medicare ID - Type Unspecified