Provider Demographics
NPI:1134773542
Name:GATTONE, MARISSA IRENE (LCGC)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:IRENE
Last Name:GATTONE
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:IRENE
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCGC
Mailing Address - Street 1:14665 RANDALL CUNNINGHAM
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-1019
Mailing Address - Country:US
Mailing Address - Phone:267-229-5304
Mailing Address - Fax:
Practice Address - Street 1:14665 RANDALL CUNNINGHAM
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-1019
Practice Address - Country:US
Practice Address - Phone:267-229-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000473170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS