Healthcare Provider Details

I. General information

NPI: 1083784052
Provider Name (Legal Business Name): MARINA J ROSE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 SHERWOOD AVE STE 100
LOS ALTOS CA
94022-1334
US

IV. Provider business mailing address

90 E TASMAN DR
SAN JOSE CA
95134-1617
US

V. Phone/Fax

Practice location:
  • Phone: 650-949-3636
  • Fax:
Mailing address:
  • Phone: 408-944-6100
  • Fax: 408-944-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number23044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: