Provider Demographics
NPI:1740980531
Name:KO, GINA MAROTTO (PHARMD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MAROTTO
Last Name:KO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LORENE
Other - Last Name:MAROTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:310 BALLYMORE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3932
Mailing Address - Country:US
Mailing Address - Phone:415-606-4444
Mailing Address - Fax:
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671311835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care