Provider Demographics
NPI:1508599895
Name:SMIT, MARISSA M
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:SMIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MINT PLZ APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1866
Mailing Address - Country:US
Mailing Address - Phone:559-288-2558
Mailing Address - Fax:
Practice Address - Street 1:3450 3RD ST STE 1C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1444
Practice Address - Country:US
Practice Address - Phone:415-437-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program