MEDICARE: DR. MARILYN MASTEN HONEGGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G53701	CA

General Provider Information

NPI Number	:	1376548156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN MASTEN HONEGGER M.D.

Provider Business Mailing Address
First Line	:	12 CAMINO ENCINAS
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-3309
Country	:	US
Telephone Number	:	510-204-8180
Fax Number	:	925-254-0687

Provider Business Practice Location Address
First Line	:	12 CAMINO ENCINAS
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-3309
Country	:	US
Telephone Number	:	510-204-8180
Fax Number	:	925-254-0687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/21/2011

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