Provider Demographics
NPI:1922181213
Name:VOLLUCCI, MARIA MARINI (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MARINI
Last Name:VOLLUCCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3640 LOMITA BLVD
Mailing Address - Street 2:#309
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3927
Mailing Address - Country:US
Mailing Address - Phone:310-465-1604
Mailing Address - Fax:310-465-1607
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:#309
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3927
Practice Address - Country:US
Practice Address - Phone:310-465-1604
Practice Address - Fax:310-465-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00600860OtherRAILROAD MEDICARE
P00600860OtherRAILROAD MEDICARE
CAG94932Medicare UPIN