Provider Demographics
NPI:1093461568
Name:TOP MARROQUIN, SANTOS GIOVANNI (CMT)
Entity Type:Individual
Prefix:
First Name:SANTOS
Middle Name:GIOVANNI
Last Name:TOP MARROQUIN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N EL CAMINO REAL
Mailing Address - Street 2:APT 221
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-946-6556
Mailing Address - Fax:
Practice Address - Street 1:316 N EL CAMINO REAL
Practice Address - Street 2:APT 221
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-946-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist