Provider Demographics
NPI:1356692206
Name:MARINO, ALEXA ROSS (CPNP)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:ROSS
Last Name:MARINO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1209
Mailing Address - Country:US
Mailing Address - Phone:773-835-2789
Mailing Address - Fax:
Practice Address - Street 1:1701 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2412
Practice Address - Country:US
Practice Address - Phone:415-826-1701
Practice Address - Fax:415-826-1704
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95122397163W00000X
CA95006469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse