Healthcare Provider Details

I. General information

NPI: 1003583436
Provider Name (Legal Business Name): FREDERICK V MARINO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N MARTIN AVE
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

8690 SIERRA COLLEGE BLVD STE 160-324
ROSEVILLE CA
95661-5961
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-3808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: