Provider Demographics
NPI:1497898043
Name:MULVEY, MARINA MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:MARIE
Last Name:MULVEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 HOEN AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-9405
Mailing Address - Country:US
Mailing Address - Phone:707-542-1154
Mailing Address - Fax:707-542-4818
Practice Address - Street 1:4725 HOEN AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-9405
Practice Address - Country:US
Practice Address - Phone:707-542-1154
Practice Address - Fax:707-542-4818
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1683231H00000X
CAHA3313237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0016830Medicaid
ZZZ229512YMedicare UPIN