Healthcare Provider Details

I. General information

NPI: 1790183424
Provider Name (Legal Business Name): MARYNA PIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650B FREMONT AVE
LOS ALTOS CA
94024-4812
US

IV. Provider business mailing address

650B FREMONT AVE
LOS ALTOS CA
94024-4812
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: