Provider Demographics
NPI:1457963910
Name:ROUFAIL, MAREENA (OD)
Entity type:Individual
Prefix:
First Name:MAREENA
Middle Name:
Last Name:ROUFAIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2498
Mailing Address - Country:US
Mailing Address - Phone:510-985-5100
Mailing Address - Fax:510-985-5223
Practice Address - Street 1:3100 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2498
Practice Address - Country:US
Practice Address - Phone:510-985-5100
Practice Address - Fax:510-985-5223
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61092875152W00000X
CA34899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist