Provider Demographics
NPI:1609041219
Name:MAROVICH, PATRICIA LOUISE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:MAROVICH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7174 SANTA TERESA BLVD A-6
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139
Mailing Address - Country:US
Mailing Address - Phone:408-363-1498
Mailing Address - Fax:408-363-1599
Practice Address - Street 1:7174 SANTA TERESA BLVD STE A6
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1350
Practice Address - Country:US
Practice Address - Phone:408-363-1498
Practice Address - Fax:408-363-1599
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245344163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice