Provider Demographics
NPI:1851498133
Name:MARINELLI & FELDMAN MDS
Entity Type:Organization
Organization Name:MARINELLI & FELDMAN MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-879-2410
Mailing Address - Street 1:1915 SUNNY CREST DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3626
Mailing Address - Country:US
Mailing Address - Phone:714-879-2410
Mailing Address - Fax:714-879-5340
Practice Address - Street 1:1915 SUNNY CREST DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3626
Practice Address - Country:US
Practice Address - Phone:714-879-2410
Practice Address - Fax:714-879-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59971208800000X, 208800000X
CAA79874208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0684380OtherCLIA
CAG41816OtherMEDI CAL RENDERING
CAG59971OtherMEDI-CAL RENDERING
CAGR0011581Medicaid
CAE91849Medicare UPIN
CAWG59971CMedicare PIN
CAWG41816BMedicare PIN
CAWA79874CMedicare PIN
CAWG59971BMedicare PIN
CAG41816OtherMEDI CAL RENDERING
CAWG59971AMedicare PIN
CAA48702Medicare UPIN
CAW450AMedicare PIN
CAWA79874AMedicare PIN
CAWG41816AMedicare PIN
CAW450Medicare PIN
CAH66701Medicare UPIN
CA05D0684380OtherCLIA
CAGR0011581Medicaid