Healthcare Provider Details

I. General information

NPI: 1831932227
Provider Name (Legal Business Name): MARISSA RAQUEL HARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST # 130
WEST COVINA CA
91791-1637
US

IV. Provider business mailing address

100 N BARRANCA ST # 103
WEST COVINA CA
91791-1637
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax:
Mailing address:
  • Phone: 626-433-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number741554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: