Siamak Stephen Marzban,M.D.,Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A048221 Issued in CA

Legal business name

SIAMAK STEPHEN MARZBAN,M.D.,INC

Practice address

2403 S Moray Ave
San Pedro, CA 90732-4342

Phone

(310) 832-2694

Fax

(310) 547-0140

NPI assigned

Nov 4, 2010

Last updated

Nov 4, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Siamak Stephen Marzban, M.D.NPI 1164447959

Title

President

Phone

(310) 832-2694

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Siamak Stephen Marzban, M.D.

  • Internal Medicine Physician
  • San Pedro, CA
  • NPI 1164447959
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288828800000",
    "number": "1699076885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 S MORAY AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907324342",
            "telephone_number": "310-832-2694",
            "fax_number": "310-547-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 S MORAY AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907324342",
            "telephone_number": "310-832-2694",
            "fax_number": "310-547-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIAMAK STEPHEN MARZBAN,M.D.,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2010-11-04",
        "status": "A",
        "authorized_official_last_name": "MARZBAN",
        "authorized_official_first_name": "SIAMAK",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-832-2694",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A048221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A482211",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shoreline Wellness Multi (shoreline Wellness)
• Jennifer Elizabeth Shortt, LCSW
• Robert Shrubb, RADT
• Kapil Shukla
• Paloma Shukla
• Jasmine Siitia
• Hawanatu Sillah
• David Vernon Silva, LCSW
• James Darren Dizon Simbulan
• Kim Simmonds, LMFT

• Clinic/Center in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.