Provider Demographics
NPI:1295925311
Name:SYRETT, MARILYN (DO)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SYRETT
Suffix:
Gender:F
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 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1740
Mailing Address - Country:US
Mailing Address - Phone:949-310-4393
Mailing Address - Fax:949-313-1835
Practice Address - Street 1:3991 MACARTHUR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3048
Practice Address - Country:US
Practice Address - Phone:949-310-4393
Practice Address - Fax:949-313-1835
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7905207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22629Medicare PIN
CAH48919Medicare UPIN