Provider Demographics
NPI:1760500797
Name:MARINO, JOSEPH T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:MARINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3399
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:6600 MERCY CT STE 180B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3198
Practice Address - Country:US
Practice Address - Phone:916-962-3112
Practice Address - Fax:916-962-1536
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG3874202080P0214X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38742Medicaid
CAG38742Medicaid
A47579Medicare UPIN