Provider Demographics
NPI:1760430680
Name:CHRIS MARASCO, M.D., INC.
Entity Type:Organization
Organization Name:CHRIS MARASCO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-528-1080
Mailing Address - Street 1:4940 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1741
Mailing Address - Country:US
Mailing Address - Phone:818-528-1080
Mailing Address - Fax:818-528-1255
Practice Address - Street 1:4940 VAN NUYS BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1741
Practice Address - Country:US
Practice Address - Phone:818-528-1080
Practice Address - Fax:818-528-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19901Medicare ID - Type UnspecifiedCORPORATE MEDICARE NUMBER