Provider Demographics
NPI:1780987537
Name:LUIS MARMANILLO-ALCAZAR, M.D.,INC.
Entity type:Organization
Organization Name:LUIS MARMANILLO-ALCAZAR, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:MARMANILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-585-7117
Mailing Address - Street 1:340 4TH AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-585-7117
Mailing Address - Fax:619-585-7146
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-585-7117
Practice Address - Fax:619-585-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B-50368Medicare UPIN