Healthcare Provider Details

I. General information

NPI: 1922577915
Provider Name (Legal Business Name): MARINA KIILANI RUPPERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 LINCOLN BLVD # 325
LINCOLN CA
95648-6303
US

IV. Provider business mailing address

69 LINCOLN BLVD # 325
LINCOLN CA
95648-6303
US

V. Phone/Fax

Practice location:
  • Phone: 916-249-8497
  • Fax:
Mailing address:
  • Phone: 916-249-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: