Provider Demographics
NPI:1336553197
Name:SCHWARTZ, MARISSA A (MD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4507
Mailing Address - Country:US
Mailing Address - Phone:562-427-0550
Mailing Address - Fax:562-988-8899
Practice Address - Street 1:433 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4507
Practice Address - Country:US
Practice Address - Phone:562-427-0550
Practice Address - Fax:562-988-8899
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2021-10-11
Deactivation Date:2021-09-28
Deactivation Code:
Reactivation Date:2021-10-07
Provider Licenses
StateLicense IDTaxonomies
CAA168513207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology