Provider Demographics
NPI:1942923180
Name:SILVA, MARCELI COIMBRA DE CIMA
Entity Type:Individual
Prefix:
First Name:MARCELI
Middle Name:COIMBRA DE CIMA
Last Name:SILVA
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 1:1500 LINCOLN VILLAGE CIR APT 2310
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1672
Mailing Address - Country:US
Mailing Address - Phone:949-346-6243
Mailing Address - Fax:
Practice Address - Street 1:910 DIABLO AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-7311
Practice Address - Country:US
Practice Address - Phone:415-898-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist