Healthcare Provider Details

I. General information

NPI: 1699235325
Provider Name (Legal Business Name): MARISSA JOSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SILLECT AVE STE 100
BAKERSFIELD CA
93308-6372
US

IV. Provider business mailing address

PO BOX 1139
BAKERSFIELD CA
93302-1139
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-8384
  • Fax: 661-323-9320
Mailing address:
  • Phone: 661-371-2767
  • Fax: 661-438-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12180261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: