Healthcare Provider Details

I. General information

NPI: 1316159957
Provider Name (Legal Business Name): GAIL ELLEN MARASSE DC, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S EVERGREEN DR
VENTURA CA
93003-2609
US

IV. Provider business mailing address

2419 HARBOR BLVD 134
VENTURA CA
93001-3904
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-0822
  • Fax:
Mailing address:
  • Phone: 805-641-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number22066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: