Provider Demographics
NPI:1912106675
Name:MARANTZ, LORI (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:MARANTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:IMPERIALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1602 TERRA BELLA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2026
Mailing Address - Country:US
Mailing Address - Phone:443-604-0792
Mailing Address - Fax:
Practice Address - Street 1:1900 E 4TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3962
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC525172084P0800X
MDD00603952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry