Provider Demographics
NPI:1245667013
Name:ROBERT J MARRIOTT MEDICAL CORP
Entity type:Organization
Organization Name:ROBERT J MARRIOTT MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-524-1320
Mailing Address - Street 1:222 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 2175
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5639
Mailing Address - Country:US
Mailing Address - Phone:310-524-1320
Mailing Address - Fax:310-706-4212
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:310-524-1320
Practice Address - Fax:310-706-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty