Provider Demographics
NPI:1306937230
Name:VINCENT C. MARINO, DPM, INC
Entity type:Organization
Organization Name:VINCENT C. MARINO, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:916-452-2005
Mailing Address - Street 1:2801 K ST
Mailing Address - Street 2:410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-452-2005
Mailing Address - Fax:415-984-9920
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:410
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-452-2005
Practice Address - Fax:415-984-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3530213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU12475Medicare UPIN