Healthcare Provider Details

I. General information

NPI: 1699603811
Provider Name (Legal Business Name): NADYA ELENA MARRUFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SONOMA AVE
SANTA ROSA CA
95405-4819
US

IV. Provider business mailing address

507 VALLEY WAY
MILPITAS CA
95035-4105
US

V. Phone/Fax

Practice location:
  • Phone: 707-787-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: