Basic Information
| Provider Information | |||||||||
| NPI: | 1992722359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATALA | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3687 MT DIABLO BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945493717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168546975 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 ASHBY AVE | ||||||||
| Address2: | ROOM 5505 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102044444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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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 | 208M00000X | 230056 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | A104889 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | A104889 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A104889 | 01 | CA | STATE LICENSE | OTHER |