Provider Demographics
NPI:1184771040
Name:DANIEL MARCUS MD INC
Entity type:Organization
Organization Name:DANIEL MARCUS MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-305-1813
Mailing Address - Street 1:PO BOX 66459
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-0459
Mailing Address - Country:US
Mailing Address - Phone:310-305-1813
Mailing Address - Fax:310-821-3555
Practice Address - Street 1:4640 ADMIRALTY WAY STE 1020
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6641
Practice Address - Country:US
Practice Address - Phone:310-305-1813
Practice Address - Fax:310-821-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417061714OtherNPI
CA1417061714OtherNPI