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General NPI Number Information
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NPI Number | 1780106252
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Entity Type | Individual
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Provider Name | MARISSA ROQUE RIDAO-ROBERTSON RPH
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Gender | Female
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Dates
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Enumeration Date | 07/16/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 855 EL CAMINO REAL
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City | PALO ALTO
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State | CA
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Zip | 94301-2305
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Country | US
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Telephone | 650-322-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 AMBERWOOD DR
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City | FREMONT
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State | CA
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Zip | 94555-3856
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Country | US
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Telephone | 510-241-8613
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 72601
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License Number State | CA
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