Provider Demographics
NPI:1063684850
Name:DULDULAO, MARJUN PHILIP NARCISO III (MD)
Entity type:Individual
Prefix:DR
First Name:MARJUN
Middle Name:PHILIP NARCISO
Last Name:DULDULAO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:MARJUN
Other - Last Name:DULDULAO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3690
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO STREET SUITE 6200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109414208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program