Provider Demographics
NPI:1013961796
Name:FARRONAN, MARLENE F (PA)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:F
Last Name:FARRONAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:F
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:DEPT LA 23039
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3039
Mailing Address - Country:US
Mailing Address - Phone:562-282-4038
Mailing Address - Fax:562-658-3397
Practice Address - Street 1:9040 TELEGRAPH RD STE 100
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2395
Practice Address - Country:US
Practice Address - Phone:562-861-0954
Practice Address - Fax:562-923-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q58772Medicare UPIN
CAWPA11792BMedicare PIN