Provider Demographics
NPI:1790665040
Name:PERNOUX, MARION (CAMTC)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:PERNOUX
Suffix:
Gender:F
Credentials:CAMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2914
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94126-2914
Mailing Address - Country:US
Mailing Address - Phone:415-867-6002
Mailing Address - Fax:
Practice Address - Street 1:21 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2124
Practice Address - Country:US
Practice Address - Phone:415-355-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty