Provider Demographics
NPI:1730105123
Name:STANISLAUS, MAREENI (MD)
Entity type:Individual
Prefix:DR
First Name:MAREENI
Middle Name:
Last Name:STANISLAUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-434-5497
Mailing Address - Fax:805-434-0917
Practice Address - Street 1:350 POSADA LN STE 201
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4060
Practice Address - Country:US
Practice Address - Phone:805-434-3000
Practice Address - Fax:805-329-5229
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG82207207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092204Medicaid
CA00G822070Medicaid
CACB218342OtherMEDICARE ID
CAGR0092204Medicaid
CA00G822070Medicaid