Provider Demographics
NPI:1225869373
Name:MARIGOMEN, ROSSELLE YCOT (FNP-BC)
Entity type:Individual
Prefix:
First Name:ROSSELLE
Middle Name:YCOT
Last Name:MARIGOMEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 HAYTER AVE UNIT 1/2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3121
Mailing Address - Country:US
Mailing Address - Phone:415-909-9469
Mailing Address - Fax:
Practice Address - Street 1:16025 GALE AVE STE B10
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91745-1633
Practice Address - Country:US
Practice Address - Phone:626-336-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily