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General NPI Number Information
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NPI Number | 1174593206
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Entity Type | Individual
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Provider Name | MARISELA MARISA NOORHASAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 900 S ELISEO DR STE 201
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City | GREENBRAE
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State | CA
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Zip | 94904-2153
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Country | US
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Telephone | 415-461-1780
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26666
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A88449
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A88449
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD2014-0776
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2014-0776
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License Number State | NM
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