Provider Demographics
NPI:1639489818
Name:HARRY MARSHAK MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HARRY MARSHAK MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-2551
Mailing Address - Street 1:74075 EL PASEO STE D2
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4118
Mailing Address - Country:US
Mailing Address - Phone:760-341-2551
Mailing Address - Fax:760-341-2522
Practice Address - Street 1:74075 EL PASEO STE D2
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4118
Practice Address - Country:US
Practice Address - Phone:760-341-2551
Practice Address - Fax:760-341-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70631261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center