Provider Demographics
NPI:1770732760
Name:VIRUEZ, MARCO JESUS (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:JESUS
Last Name:VIRUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NORTH BRAND BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-396-8050
Mailing Address - Fax:818-844-3888
Practice Address - Street 1:700 NORTH BRAND BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-396-8050
Practice Address - Fax:818-844-3888
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine