Provider Demographics
NPI:1487976106
Name:MARSHAL P FICHMAN MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:MARSHAL P FICHMAN MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-5784
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 292W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-271-5784
Mailing Address - Fax:310-289-8801
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 292W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-271-5784
Practice Address - Fax:310-289-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19736261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A197360Medicaid
CAA82106Medicare UPIN
CA00A197360Medicaid