Healthcare Provider Details

I. General information

NPI: 1639146517
Provider Name (Legal Business Name): NATANYA LILLIAN MARRACINO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1516
SAN FRANCISCO CA
94102-1306
US

IV. Provider business mailing address

490 POST ST STE 1516
SAN FRANCISCO CA
94102-1306
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-4964
  • Fax: 415-398-0147
Mailing address:
  • Phone: 415-398-4964
  • Fax: 415-398-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number58169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: