MEDICARE: MS. MARISSA ANN MAPLE

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	367500000X	Certified Registered Nurse Anesthetist	NA95001898	CA

General Provider Information

NPI Number	:	1508510587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISSA ANN MAPLE

Provider Business Mailing Address
First Line	:	22325 REGNART RD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-4824
Country	:	US
Telephone Number	:	408-813-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 N CAMDEN DR STE 1010
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4515
Country	:	US
Telephone Number	:	408-813-7446
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	04/08/2023

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