Active NPI
Michael Marinello
- Nurse Practitioner
- Pomona, CA
National Provider Identifier
1013474790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95010321
- Practice address
- 255 E Bonita Ave
Pomona, CA 91767-1923 - Phone
- (909) 643-2980
- NPI assigned
- Feb 28, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95010321 | CA | Primary |
Addresses
Primary practice location
255 E Bonita Ave
Pomona, CA 91767-1923
Mailing address
6426 Kettle Peak PL
Rancho Cucamonga, CA 91737-6510
Phone (909) 472-2678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95010321 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551312000000",
"number": "1013474790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6426 KETTLE PEAK PL",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917376510",
"telephone_number": "909-472-2678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 E BONITA AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917671923",
"telephone_number": "909-643-2980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARINELLO",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-28",
"last_updated": "2019-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95010321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.