Provider Demographics
NPI:1093380065
Name:BARAK-MARINO, ADI
Entity Type:Individual
Prefix:
First Name:ADI
Middle Name:
Last Name:BARAK-MARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 FILLMORE ST # 16146
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1814
Mailing Address - Country:US
Mailing Address - Phone:415-515-5492
Mailing Address - Fax:
Practice Address - Street 1:140 BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2102
Practice Address - Country:US
Practice Address - Phone:415-515-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse