Provider Demographics
NPI:1093894016
Name:JASAN, MARILEE CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:CATHERINE
Last Name:JASAN
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 1:311 MILLER AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2844
Mailing Address - Country:US
Mailing Address - Phone:415-388-5100
Mailing Address - Fax:415-388-5155
Practice Address - Street 1:311 MILLER AVE
Practice Address - Street 2:SUITE I
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2844
Practice Address - Country:US
Practice Address - Phone:415-388-5100
Practice Address - Fax:415-388-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20511Medicare UPIN
CA00G722401Medicare ID - Type Unspecified