Provider Demographics
NPI:1528171345
Name:SOOSAIPILLAI, MARINA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SOOSAIPILLAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 Q ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7058
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:916-733-5385
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA396732085R0202X
TXE75122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1744051OtherGREAT WEST
CAMCMG172000OtherWESTERN HEALTH ADVANTAGE
CA248480OtherINTERPLAN
CA7686252OtherAETNA
CA3044732OtherCIGNA
CA000810342628OtherPHCS
CA059196OtherHEALTH NET
CA90133715OtherPACIFICARE
CA1950239OtherFIRST HEALTH
CA2008968OtherUNITED HEALTHCARE
CAA39673OtherBLUE CROSS
CA1950239OtherFIRST HEALTH
CA3044732OtherCIGNA