Healthcare Provider Details

I. General information

NPI: 1891431227
Provider Name (Legal Business Name): DANIEL JAMES MARRIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 POPE CT
SANTA ROSA CA
95405-4710
US

IV. Provider business mailing address

1275 4TH ST # 118
SANTA ROSA CA
95404-4057
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-3751
  • Fax: 707-568-5391
Mailing address:
  • Phone: 707-529-3562
  • Fax: 707-568-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberG12867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: