Healthcare Provider Details

I. General information

NPI: 1114976149
Provider Name (Legal Business Name): MICHELLE A MARINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N VENTURA RD STE 110
OXNARD CA
93036-9705
US

IV. Provider business mailing address

2901 N VENTURA RD STE 110
OXNARD CA
93036-9705
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-6163
  • Fax: 805-981-6189
Mailing address:
  • Phone: 805-981-6163
  • Fax: 805-981-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG69257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: