Provider Demographics
NPI:1992848980
Name:MARIANO, ROBERTO H (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:H
Last Name:MARIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12030 RIVERSIDE DR
Mailing Address - Street 2:#A
Mailing Address - City:N.HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-655-9902
Mailing Address - Fax:818-655-9909
Practice Address - Street 1:12030 RIVERSIDE DR
Practice Address - Street 2:#A
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3749
Practice Address - Country:US
Practice Address - Phone:818-655-9902
Practice Address - Fax:818-655-9909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF68059Medicare ID - Type Unspecified