Healthcare Provider Details

I. General information

NPI: 1295520245
Provider Name (Legal Business Name): MAKINLEY MARLENE KRATINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

PO BOX 27573
SAN FRANCISCO CA
94127-0573
US

V. Phone/Fax

Practice location:
  • Phone: 451-925-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberH13864460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: