Basic Information
| Provider Information | |||||||||
| NPI: | 1043656812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARINOAK, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 W MONTE VISTA AVE | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956883620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074493400 | ||||||||
| FaxNumber: | 7074500954 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 HEIGHT ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933052840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618722324 | ||||||||
| FaxNumber: | 6618714661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2013 | ||||||||
| LastUpdateDate: | 05/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | THEKKEK | ||||||||
| AuthorizedOfficialFirstName: | PREMA | ||||||||
| AuthorizedOfficialMiddleName: | PHILIP | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY / VP | ||||||||
| AuthorizedOfficialTelephone: | 7073300000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, NHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.