Provider Demographics
NPI:1568246320
Name:MARISCAL, MARIA TERESA MARIN (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA MARIN
Middle Name:
Last Name:MARISCAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 E ARTESIA BLVD APT 23
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2790
Mailing Address - Country:US
Mailing Address - Phone:323-712-1141
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE STE 17
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1729
Practice Address - Country:US
Practice Address - Phone:714-522-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist