Provider Demographics
NPI:1801897103
Name:JALIL, MARIAN (M D)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:JALIL
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 WHITTIER BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2148
Mailing Address - Country:US
Mailing Address - Phone:562-945-7671
Mailing Address - Fax:562-945-7485
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2148
Practice Address - Country:US
Practice Address - Phone:562-945-7671
Practice Address - Fax:562-945-7485
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA408630207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA408630Medicaid
CAA408630Medicare ID - Type Unspecified
B50446Medicare UPIN