Healthcare Provider Details

I. General information

NPI: 1902644735
Provider Name (Legal Business Name): VIRENE JULIET MARROQUIN NUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 SAN CARLOS AVE STE B
SAN CARLOS CA
94070-2317
US

IV. Provider business mailing address

650 GILMAN AVE
SAN FRANCISCO CA
94124-3734
US

V. Phone/Fax

Practice location:
  • Phone: 650-394-5155
  • Fax: 650-332-2946
Mailing address:
  • Phone: 650-284-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: