Provider Demographics
NPI:1578216511
Name:MARANO, CHRISTIAN GEGAJO
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:GEGAJO
Last Name:MARANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 O ST # MS -21
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5804
Mailing Address - Country:US
Mailing Address - Phone:916-224-8260
Mailing Address - Fax:
Practice Address - Street 1:1215 O ST # MS -21
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5804
Practice Address - Country:US
Practice Address - Phone:916-224-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily