Provider Demographics
NPI:1477647121
Name:FRIEDMAN, MARNI JONNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARNI
Middle Name:JONNA
Last Name:FRIEDMAN
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 1:901 SUNSET DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5613
Mailing Address - Country:US
Mailing Address - Phone:831-637-7466
Mailing Address - Fax:831-637-9757
Practice Address - Street 1:901 SUNSET DR STE 2
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5613
Practice Address - Country:US
Practice Address - Phone:831-637-7466
Practice Address - Fax:831-637-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA065852OtherLICENSE
CAG91364Medicare UPIN
CA00A658520Medicare ID - Type Unspecified