Healthcare Provider Details

I. General information

NPI: 1174546261
Provider Name (Legal Business Name): JOSEPH T. MARINO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 COYLE AVENUE SUITE 330
CARMICHAEL CA
95608-0303
US

IV. Provider business mailing address

6660 COYLE AVENUE SUITE 330
CARMICHAEL CA
95608-0303
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-3112
  • Fax: 916-962-1536
Mailing address:
  • Phone: 916-962-3112
  • Fax: 916-962-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberG38742
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG38742
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH T. MARINO JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 916-962-3112