Provider Demographics
NPI:1770818395
Name:AYAD, MARIANNE BOTROS (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:BOTROS
Last Name:AYAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:BOTROS
Other - Last Name:YOUSEF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4051 VIA DOLCE
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5027
Mailing Address - Country:US
Mailing Address - Phone:310-306-4346
Mailing Address - Fax:310-306-3177
Practice Address - Street 1:4051 VIA DOLCE
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5027
Practice Address - Country:US
Practice Address - Phone:310-306-4346
Practice Address - Fax:310-306-3177
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106240261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care