Healthcare Provider Details

I. General information

NPI: 1548306590
Provider Name (Legal Business Name): MARINA PODIATRY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2477 CHESTNUT STREET
SAN FRANCISCO CA
94123-2505
US

IV. Provider business mailing address

2477 CHESTNUT STREET
SAN FRANCISCO CA
94123-2505
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-1922
  • Fax: 415-921-0771
Mailing address:
  • Phone: 415-921-1922
  • Fax: 415-921-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1141
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD H MICHAEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 415-921-1922