Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 22066 | CA |
NPI | 1316159957 |
---|---|
Provider Name | Dr. Gail Ellen Marasse |
First Address | Ventura, CA 93001-3904 |
Second Address | Ventura, CA 93003-2609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |