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NPI Code Detail

MEDICARE: KATEY MARIN

MEDICARE: KATEY MARIN
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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1457737074
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATEY MARIN
Provider Business Mailing Address
First Line : 548 RINALDO ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-2840
Country : US
Telephone Number : 707-321-8647
Fax Number :
Provider Business Practice Location Address
First Line : 101 H ST STE L
Second Line :
City : PETALUMA
State : CA
Zip : 94952-5100
Country : US
Telephone Number : 866-206-2008
Fax Number : 866-317-1665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2015
Last Update Date : 03/11/2019

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Directions to “ KATEY MARIN ” Practice Location

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