Provider Demographics
NPI:1053408021
Name:LUISI, MARCIA ANN (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:LUISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SONOMA AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4802
Mailing Address - Country:US
Mailing Address - Phone:707-546-5487
Mailing Address - Fax:707-546-5488
Practice Address - Street 1:990 SONOMA AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4802
Practice Address - Country:US
Practice Address - Phone:707-546-5487
Practice Address - Fax:707-546-5488
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61709208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G617090Medicaid
CA00G617090Medicare ID - Type Unspecified
CAE24864Medicare UPIN