Basic Information
| Provider Information | |||||||||
| NPI: | 1245669803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARINI | ||||||||
| FirstName: | GERALD | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7233 E BASELINE RD STE 126 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852095007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806992222 | ||||||||
| FaxNumber: | 4806993033 | ||||||||
| Practice Location | |||||||||
| Address1: | 7233 E BASELINE RD STE 126 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852095007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806992222 | ||||||||
| FaxNumber: | 4806993033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5588 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 5588 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.