Provider Demographics
NPI:1699299727
Name:MARIANO, JOEL MARCEL (FNP)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:MARCEL
Last Name:MARIANO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:MARCEL
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST, 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-2856
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:8220 WYMARK DR STE 200
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6298
Practice Address - Country:US
Practice Address - Phone:916-667-0600
Practice Address - Fax:916-683-0232
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006649363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner