Provider Demographics
NPI:1912040296
Name:MANI, MARC EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWARD
Last Name:MANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9675 BRIGHTON WAY
Mailing Address - Street 2:SUITE #340
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5100
Mailing Address - Country:US
Mailing Address - Phone:310-203-0511
Mailing Address - Fax:310-859-9820
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:SUITE #340
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5100
Practice Address - Country:US
Practice Address - Phone:310-203-0511
Practice Address - Fax:310-859-9820
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75271208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM7354753OtherDEA
A75271Medicare UPIN
A75271Medicare ID - Type UnspecifiedSTATE LICENSE