MEDICARE: MARINA ZOTOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	67719	CA

General Provider Information

NPI Number	:	1144889031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA ZOTOVA

Provider Business Mailing Address
First Line	:	593 BLAIRBURRY WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 EL MONTE AVE
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2320
Country	:	US
Telephone Number	:	650-961-5560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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Directions to “ MARINA ZOTOVA ” Practice Location

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