Healthcare Provider Details

I. General information

NPI: 1700461241
Provider Name (Legal Business Name): MARINA AWWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FOLSOM ST FL 1
SAN FRANCISCO CA
94107-4226
US

IV. Provider business mailing address

208 ALBANY AVE
VACAVILLE CA
95687-5704
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 707-301-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: