Healthcare Provider Details

I. General information

NPI: 1013087444
Provider Name (Legal Business Name): VINCENT C. MARINO DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 DAVIS CT
SAN FRANCISCO CA
94111-2402
US

IV. Provider business mailing address

430 DAVIS CT
SAN FRANCISCO CA
94111-2402
US

V. Phone/Fax

Practice location:
  • Phone: 415-984-2700
  • Fax: 415-984-9920
Mailing address:
  • Phone: 415-984-2700
  • Fax: 415-984-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE3530
License Number StateCA

VIII. Authorized Official

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