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General NPI Number Information
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NPI Number | 1346621638
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Entity Type | Individual
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Provider Name | TARA ELIZABETH MARINO RD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 405 14TH ST SUITE 610
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City | OAKLAND
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State | CA
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Zip | 94612-2715
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Country | US
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Telephone | 510-922-8208
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 PEASE CT
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City | ALAMEDA
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State | CA
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Zip | 94501-4617
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Country | US
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Telephone | 510-755-6909
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 959124
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License Number State | CA
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