Healthcare Provider Details

I. General information

NPI: 1881270940
Provider Name (Legal Business Name): PAUL NICHOLAS MARINOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-464-1982
  • Fax: 925-464-2042
Mailing address:
  • Phone: 925-464-1982
  • Fax: 925-464-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6043
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: