Provider Demographics
NPI:1669098448
Name:MARIANO, DENISE INTAL (CLS PHM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:INTAL
Last Name:MARIANO
Suffix:
Gender:F
Credentials:CLS PHM
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:INTAL
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3102 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5465
Mailing Address - Country:US
Mailing Address - Phone:415-516-0749
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-516-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1083246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management