Provider Demographics
NPI:1194926592
Name:MARIAN JALIL M D INC
Entity type:Organization
Organization Name:MARIAN JALIL M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JALIL
Authorized Official - Suffix:
Authorized Official - Credentials:M D INC
Authorized Official - Phone:562-945-7671
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW10442207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA408630Medicare ID - Type Unspecified
CAB50446Medicare UPIN
CAW10442Medicare ID - Type Unspecified