Provider Demographics
NPI:1790009637
Name:THIEM, MARVIN DUGLAS
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DUGLAS
Last Name:THIEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41002 COUNTY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6027
Mailing Address - Country:US
Mailing Address - Phone:951-600-6360
Mailing Address - Fax:951-600-6365
Practice Address - Street 1:41002 COUNTY CENTER DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6027
Practice Address - Country:US
Practice Address - Phone:951-600-6360
Practice Address - Fax:951-600-6365
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management