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General NPI Number Information
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NPI Number | 1699299727
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Entity Type | Individual
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Provider Name | JOEL MARCEL MARIANO FNP
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Gender | Male
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 8220 WYMARK DR STE 200
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City | ELK GROVE
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State | CA
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Zip | 95757-6298
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Country | US
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Telephone | 916-667-0600
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Fax | 916-683-0232
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Provider Business Mailing Address
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Address Line | 1800 HARRISON ST, 7TH FL
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City | OAKLAND
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State | CA
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Zip | 94612-3429
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Country | US
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Telephone | 510-625-2856
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Fax | 877-738-4262
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95006649
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006649
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License Number State | CA
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