Provider Demographics
NPI:1831147024
Name:SAUNDERS, MARVOUS (MD)
Entity type:Individual
Prefix:
First Name:MARVOUS
Middle Name:
Last Name:SAUNDERS
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 1:2621 SOUTH BRISTOL
Mailing Address - Street 2:#102
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-662-1771
Mailing Address - Fax:714-662-1116
Practice Address - Street 1:2621 SOUTH BRISTOL
Practice Address - Street 2:#102
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-662-1771
Practice Address - Fax:714-662-1116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17298207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00G172980Medicaid
A40043Medicare UPIN
CAG17298Medicare ID - Type Unspecified