Provider Demographics
NPI:1871866715
Name:ALFRED C. MARRONE, MD A MEDICAL CORP
Entity Type:Organization
Organization Name:ALFRED C. MARRONE, MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-530-0300
Mailing Address - Street 1:420 E 3RD ST STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-625-2694
Mailing Address - Fax:213-680-9299
Practice Address - Street 1:23441 MADISON ST STE 120
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-530-0300
Practice Address - Fax:310-530-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24447207W00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24447Medicare PIN
CAA42266Medicare UPIN