Basic Information
| Provider Information | |||||||||
| NPI: | 1114229655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWSOM | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | CATHLEEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZILIUS | ||||||||
| OtherFirstName: | MARIE | ||||||||
| OtherMiddleName: | NEWSOM | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11875 DUBLIN BLVD | ||||||||
| Address2: | STE C140 | ||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255872500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3100 TELEGRAPH AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104525231 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 01/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | NP19848 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | NP 19848 | 01 | CA | BOARD OF REGISTERED NURSING | OTHER | RN 771527 | 01 | CA | BOARD OF REGISTERED NURSING | OTHER |