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NPI Code Detail

MEDICARE: DR. MARIE CAROL PRESIDENT M.D

MEDICARE: DR. MARIE CAROL PRESIDENT M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianG078841CA

General Provider Information

NPI Number : 1083621379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIE CAROL PRESIDENT M.D
Provider Business Mailing Address
First Line : 3400 DATA DR
Second Line : ATTN: CREDENTIALING/PAYER ENROLLMENT
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 VETERANS BLVD STE 150
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-1741
Country : US
Telephone Number : 650-303-4405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 04/16/2026

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