Provider Demographics
NPI:1548306590
Name:MARINA PODIATRY ASSOCIATES INC
Entity type:Organization
Organization Name:MARINA PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-921-1922
Mailing Address - Street 1:2477 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2505
Mailing Address - Country:US
Mailing Address - Phone:415-921-1922
Mailing Address - Fax:415-921-0771
Practice Address - Street 1:2477 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2505
Practice Address - Country:US
Practice Address - Phone:415-921-1922
Practice Address - Fax:415-921-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1141213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E11410Medicaid
CA000E11410Medicaid
CA000E11410Medicare ID - Type Unspecified