Healthcare Provider Details

I. General information

NPI: 1194007393
Provider Name (Legal Business Name): MARISSA ZOSS SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23361 MADERO SUITE 200
MISSION VIEJO CA
92691-2715
US

IV. Provider business mailing address

25631 HEATHEROW CIR
LAKE FOREST CA
92630-5020
US

V. Phone/Fax

Practice location:
  • Phone: 949-581-8239
  • Fax: 949-859-0849
Mailing address:
  • Phone: 949-581-8239
  • Fax: 949-859-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: