Provider Demographics
NPI:1609226208
Name:ANAGAL, MARISHA
Entity Type:Individual
Prefix:
First Name:MARISHA
Middle Name:
Last Name:ANAGAL
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 1:208 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3310
Mailing Address - Country:US
Mailing Address - Phone:505-386-6385
Mailing Address - Fax:
Practice Address - Street 1:208 W 27TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3310
Practice Address - Country:US
Practice Address - Phone:505-386-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other