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General NPI Number Information
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NPI Number | 1265581805
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Entity Type | Individual
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Provider Name | LISA MARINELLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD PSSB 2100
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone | 916-734-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 POLE LINE RD APT 100
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City | DAVIS
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State | CA
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Zip | 95616-0535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A97234
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License Number State | CA
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