Healthcare Provider Details

I. General information

NPI: 1144889031
Provider Name (Legal Business Name): MARINA ZOTOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 EL MONTE AVE
MOUNTAIN VIEW CA
94040-2320
US

IV. Provider business mailing address

593 BLAIRBURRY WAY
SAN JOSE CA
95123-1304
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-5560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: