Provider Demographics
NPI:1124604244
Name:VOSS, MARESSA (CCP)
Entity Type:Individual
Prefix:MRS
First Name:MARESSA
Middle Name:
Last Name:VOSS
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:JONLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCP
Mailing Address - Street 1:18400 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3735
Mailing Address - Country:US
Mailing Address - Phone:847-970-0423
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1290
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119035242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
119035OtherCCP