Healthcare Provider Details

I. General information

NPI: 1154087666
Provider Name (Legal Business Name): MARITA ANN TROBOUGH CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 NATIONAL AVE STE 120
LOS GATOS CA
95032-2433
US

IV. Provider business mailing address

15400 NATIONAL AVE STE 120
LOS GATOS CA
95032-2433
US

V. Phone/Fax

Practice location:
  • Phone: 408-206-6850
  • Fax: 408-358-8435
Mailing address:
  • Phone: 408-206-6850
  • Fax: 408-358-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: