Healthcare Provider Details

I. General information

NPI: 1083848014
Provider Name (Legal Business Name): ANDRES A MARIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 EAST 12TH STREET 2ND FLOOR
OAKLAND CA
94601-3319
US

IV. Provider business mailing address

1601 FRUITVALE AVE.
OAKLAND CA
94601
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-3319
  • Fax: 510-535-4187
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA107551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: