Provider Demographics
NPI:1609871342
Name:MARINO, VINCENT C (DPM)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:C
Last Name:MARINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1911
Mailing Address - Country:US
Mailing Address - Phone:415-984-2700
Mailing Address - Fax:415-984-9920
Practice Address - Street 1:555 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1911
Practice Address - Country:US
Practice Address - Phone:415-984-2700
Practice Address - Fax:415-984-9920
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3530213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU12475Medicare UPIN
CA000E35301Medicare ID - Type UnspecifiedMCARE