Healthcare Provider Details

I. General information

NPI: 1699299727
Provider Name (Legal Business Name): JOEL MARCEL MARIANO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOEL MARCEL MARIANO

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WYMARK DR STE 200
ELK GROVE CA
95757-6298
US

IV. Provider business mailing address

1800 HARRISON ST, 7TH FL
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 916-667-0600
  • Fax: 916-683-0232
Mailing address:
  • Phone: 510-625-2856
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006649
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: