Basic Information
| Provider Information | |||||||||
| NPI: | 1679632053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALVIN MARANTZ MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7630 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926077630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496433345 | ||||||||
| FaxNumber: | 9496433560 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928823420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517366383 | ||||||||
| FaxNumber: | 9517366384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 08/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARANTZ | ||||||||
| AuthorizedOfficialFirstName: | CALVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9517366383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | G12076 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | GR0087690 | 05 | CA | MEDICAID |