Provider Demographics
NPI:1609351535
Name:RIOJAS, MARISSA DINA (LAC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:DINA
Last Name:RIOJAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 KAYE ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5555
Mailing Address - Country:US
Mailing Address - Phone:262-422-8371
Mailing Address - Fax:
Practice Address - Street 1:150 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2735
Practice Address - Country:US
Practice Address - Phone:831-393-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist