Provider Demographics
NPI:1699886564
Name:MARRIOTT, AGATA (MD)
Entity type:Individual
Prefix:DR
First Name:AGATA
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 CAMINO DEL MAR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2553
Mailing Address - Country:US
Mailing Address - Phone:858-755-0707
Mailing Address - Fax:858-755-0123
Practice Address - Street 1:1349 CAMINO DEL MAR
Practice Address - Street 2:SUITE D
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2553
Practice Address - Country:US
Practice Address - Phone:858-755-0707
Practice Address - Fax:858-755-0123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73103Medicare UPIN