Provider Demographics
NPI:1184190340
Name:WASSEF, MARYSE NAGY WADIE
Entity Type:Individual
Prefix:
First Name:MARYSE
Middle Name:NAGY WADIE
Last Name:WASSEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYSE
Other - Middle Name:NAGY WADIE
Other - Last Name:MESSIHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28131 VALERIO CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4915
Mailing Address - Country:US
Mailing Address - Phone:562-584-2373
Mailing Address - Fax:
Practice Address - Street 1:740 W ALLUVIAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5509
Practice Address - Country:US
Practice Address - Phone:888-797-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist