Provider Demographics
NPI:1457701302
Name:OPILAS, MARISSA PAGSOLINGAN (DO)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:PAGSOLINGAN
Last Name:OPILAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:925-776-7725
Mailing Address - Fax:510-506-7727
Practice Address - Street 1:350 JOHN MUIR PKWY STE 105
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5183
Practice Address - Country:US
Practice Address - Phone:925-776-7725
Practice Address - Fax:510-506-7727
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A15915OtherSTATE MEDICAL LICENSE