Organization Active NPI

Larry Marianella, MD a Professional Corp.

  • Internal Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1104128941
Registry record updated Nov 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G38835 Issued in CA
Legal business name
LARRY MARIANELLA, MD A PROFESSIONAL CORP.
Practice address
1515 Montgomery Dr
Santa Rosa, CA 95405-4500
Phone
(707) 526-4865
Fax
(707) 526-5375
NPI assigned
Nov 30, 2010
Last updated
Nov 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2010

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

Authorized official

Name
Dr. Larry Marianella, M.D.NPI 1144257486
Title
President
Phone
(707) 526-4865

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X G38835 CA Primary

Addresses

Primary practice location

1515 Montgomery Dr
Santa Rosa, CA 95405-4500

Mailing address

1515 Montgomery Dr
Santa Rosa, CA 95405-4500
Phone (707) 526-4865

National Provider Directory

National Provider Directory

Locations

1515 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 526-4865

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1104128941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054500",
            "telephone_number": "707-526-4865",
            "fax_number": "707-526-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054500",
            "telephone_number": "707-526-4865",
            "fax_number": "707-526-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY MARIANELLA, MD A PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "MARIANELLA",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-526-4865",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G38835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.