Active NPI
Melissa Anne Marino, P.A.
- Physician Assistant
- Emeryville, CA
National Provider Identifier
1285770719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA17309
- Practice address
- 2100 Powell St Ste 900
Cep - Medamerica - Credentialing Dept.
Emeryville, CA 94608-1844 - Phone
- (510) 350-2664
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA17309 | CA | Primary |
Addresses
Primary practice location
2100 Powell St Ste 900
Cep - Medamerica - Credentialing Dept.
Emeryville, CA 94608-1844
Mailing address
2100 Powell St Ste 900
Cep - Medamerica - Credentialing Dept.
Emeryville, CA 94608-1844
Phone (510) 350-2664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA17309 | Other | CA | PHYSICIAN'S ASSISTANT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA17309 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285770719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST STE 900",
"address_2": "CEP - MEDAMERICA - CREDENTIALING DEPT.",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081844",
"telephone_number": "510-350-2664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 POWELL ST STE 900",
"address_2": "CEP - MEDAMERICA - CREDENTIALING DEPT.",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081844",
"telephone_number": "510-350-2664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARINO",
"first_name": "MELISSA",
"middle_name": "ANNE",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA17309",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN'S ASSISTANT",
"identifier": "PA17309",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Emeryville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.