Provider Demographics
NPI:1174714067
Name:MARASIGAN, JUSTIN M (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:MARASIGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1303
Mailing Address - Country:US
Mailing Address - Phone:626-808-4774
Mailing Address - Fax:
Practice Address - Street 1:2241 WANKEL WAY STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0191
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:805-983-4186
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017474207R00000X
WAOP60345419207R00000X, 207RG0100X
PAOS015147207RG0100X
CA20A18363207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine