Provider Demographics
NPI:1770061939
Name:SEIFI, MARYNA
Entity type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:SEIFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SHORELINE CIR APT 375
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5085
Mailing Address - Country:US
Mailing Address - Phone:510-326-5201
Mailing Address - Fax:888-487-0030
Practice Address - Street 1:2551 SAN RAMON VALLEY BLVD STE 107B
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1661
Practice Address - Country:US
Practice Address - Phone:888-512-1200
Practice Address - Fax:888-487-0030
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist