Provider Demographics
NPI:1942778352
Name:MARASIGAN, DARYL LORRAINE OZAETA
Entity Type:Individual
Prefix:
First Name:DARYL LORRAINE
Middle Name:OZAETA
Last Name:MARASIGAN
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 1:7522 KEITH CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1517
Mailing Address - Country:US
Mailing Address - Phone:562-261-4705
Mailing Address - Fax:
Practice Address - Street 1:8580 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2520
Practice Address - Country:US
Practice Address - Phone:562-942-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist