Healthcare Provider Details

I. General information

NPI: 1184659534
Provider Name (Legal Business Name): VINCENT C. MARINO, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FRONT ST
SAN FRANCISCO CA
94111-1911
US

IV. Provider business mailing address

555 FRONT ST
SAN FRANCISCO CA
94111-1911
US

V. Phone/Fax

Practice location:
  • Phone: 415-984-2700
  • Fax:
Mailing address:
  • Phone: 415-984-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3530
License Number StateCA

VIII. Authorized Official

Name: DR. VINCENT C MARINO
Title or Position: PRESIDENT
Credential: DPM
Phone: 415-984-2700