Organization
LAKEPORT EMERGENCY MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN P. MARON M.D. (PRESIDENT)
(626) 447-0296
Entity
Organization
Contact information
Practice address
5176 HILL RD E, LAKEPORT, CA 95453-6357
(626) 447-0296
(626) 447-6057
Mailing address
PO BOX 1848, ARCADIA, CA 91077-1848
(626) 447-0296
(626) 447-6057
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G64122
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095010
—
CA
Enumeration date
10/02/2006
Last updated
07/07/2014
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