1538887344 NPI number — MARINIA GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538887344 NPI number — MARINIA GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINIA GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538887344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1968 S COAST HWY STE 3470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92651-3681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-255-8160
Provider Business Mailing Address Fax Number:
949-541-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W 4TH ST STE B61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-255-8160
Provider Business Practice Location Address Fax Number:
949-541-0042
Provider Enumeration Date:
08/17/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMBRANO
Authorized Official First Name:
SHANI
Authorized Official Middle Name:
MAISHA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-255-8160

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)