Healthcare Provider Details

I. General information

NPI: 1508146093
Provider Name (Legal Business Name): MARISSA BARAWID ALANIZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 08/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ARCHIBALD AVE
ONTARIO CA
91761-7303
US

IV. Provider business mailing address

2950 S ARCHIBALD AVE
ONTARIO CA
91761-7303
US

V. Phone/Fax

Practice location:
  • Phone: 909-923-9934
  • Fax: 909-923-0261
Mailing address:
  • Phone: 909-923-9934
  • Fax: 909-923-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH45507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: