Healthcare Provider Details

I. General information

NPI: 1407098502
Provider Name (Legal Business Name): ROSA E MARCHEBOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG. 400, SUITE 202
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD BLDG. 400, SUITE 202
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-3066
  • Fax: 831-751-6771
Mailing address:
  • Phone: 831-796-3066
  • Fax: 831-751-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: