Provider Demographics
NPI:1134839459
Name:TOPETE, MARISOL ANDREA
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:ANDREA
Last Name:TOPETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:ANDREA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27542 MANDARIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5014
Mailing Address - Country:US
Mailing Address - Phone:669-268-5931
Mailing Address - Fax:
Practice Address - Street 1:39210 STATE ST STE 204
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1456
Practice Address - Country:US
Practice Address - Phone:510-894-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46-1305562106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician