Provider Demographics
NPI:1770718728
Name:TURNER, MARISA (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:TURNER
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 1:13132 NEWPORT AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3429
Mailing Address - Country:US
Mailing Address - Phone:714-565-7960
Mailing Address - Fax:
Practice Address - Street 1:13132 NEWPORT AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3429
Practice Address - Country:US
Practice Address - Phone:714-565-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107660208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics