Marlboro Cancer Screening Center Inc

Primary specialty

Genetics Clinic/CenterTaxonomy code 261QG0250X

Legal business name

MARLBORO CANCER SCREENING CENTER INC

Doing business as

Marlboro Cancer Screening Center Inc

Practice address

11340 Mountain View Ave Ste B
Loma Linda, CA 92354-3858

Phone

(888) 267-9605

Fax

(909) 334-1314

NPI assigned

Jun 5, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dharmakumar Wilson Gomer, MD

Title

Medical Director

Phone

(909) 799-5445

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MARLBORO CANCER SCREENING CENTER INC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568678400000",
    "number": "1235797044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14164 MOUNTAIN AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917101128",
            "telephone_number": "909-927-8296",
            "fax_number": "909-334-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11340 MOUNTAIN VIEW AVE STE B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543858",
            "telephone_number": "888-267-9605",
            "fax_number": "909-334-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBORO CANCER SCREENING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-09-17",
        "status": "A",
        "authorized_official_last_name": "GOMER",
        "authorized_official_first_name": "DHARMAKUMAR",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-799-5445",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QG0250X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Genetics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA361389",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARLBORO CANCER SCREENING CENTER INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MARLBORO CANCER SCREENING CENTER INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Louis Mariglia
• Nicholas James Marinelli, DO
• Kristina Pulliam Markey, NP
• Rebecca Anne Markle, CRNA
• Michelle Laureen Marks, LVN
• Jamie Marliere
• Carmen Marmo, PA-C
• Maverick Doctolero Marpa, MD
• Silaine Marques
• Courtney Marquez, PA-C

• Clinic/Center in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.