Marilyn Jane Genneten Scoffin

Primary specialty

SpecialistTaxonomy code 174400000X

License

2377 Issued in CA

Practice address

11325 Belladonna Way
San Diego, CA 92131-2923

Phone

(619) 316-7077

NPI assigned

Oct 18, 2012

Last updated

Oct 18, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Marilyn Jane Gennetten Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1063765782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 BELLADONNA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921312923",
            "telephone_number": "619-316-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 BELLADONNA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921312923",
            "telephone_number": "619-316-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENNETEN SCOFFIN",
        "first_name": "MARILYN",
        "middle_name": "JANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "2377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "GENNETTEN",
            "middle_name": "JANE",
            "prefix": "MRS.",
            "credential": "COTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.