Provider Demographics
NPI:1811137144
Name:VADI, MARISSA GOMEZ (MD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:GOMEZ
Last Name:VADI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PATIENT SUPPORT SERVICES BLDG
Mailing Address - Street 2:4150 V STREET, SUITE 1200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-5028
Mailing Address - Fax:916-734-7980
Practice Address - Street 1:PATIENT SUPPORT SERVICES BLDG
Practice Address - Street 2:4150 V STREET, SUITE 1200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-5028
Practice Address - Fax:916-734-7980
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2018-02-06
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Provider Licenses
StateLicense IDTaxonomies
CAA106030207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology