Provider Demographics
NPI:1750423695
Name:KOBROSSI, MARCELLE E
Entity type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:E
Last Name:KOBROSSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 W GREENWOOD AVE
Mailing Address - Street 2:APT. #03
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3757
Mailing Address - Country:US
Mailing Address - Phone:909-546-1366
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:260 W. FOOTHILL BLVD.
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5048
Practice Address - Country:US
Practice Address - Phone:909-546-1366
Practice Address - Fax:909-820-7561
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55200Medicaid