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NPI Profile for MARISSA FASO in WEST SENECA, NY.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
School |
1041S0200X |
| NPI Number | 1114578218 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 09/20/2019 | |
| Last updated | 09/20/2019 - About 7 years ago | |
| Sole proprietor 1 | No | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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MARISSA FASO
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MARISSA FASO