MEDICARE: MARITESS RAZO

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	163WG0100X	Gastroenterology Registered Nurse	749646	CA

General Provider Information

NPI Number	:	1740749647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITESS RAZO

Provider Business Mailing Address
First Line	:	1411 E 31ST ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-1018
Country	:	US
Telephone Number	:	510-437-8498
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 SHELLGATE CT
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94545-1187
Country	:	US
Telephone Number	:	510-305-8464
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	03/19/2019

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Directions to “ MARITESS RAZO ” Practice Location

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