Provider Demographics
NPI:1427627546
Name:CORPUZ, MARLISA SALTIBAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARLISA
Middle Name:SALTIBAN
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 CURCI DR APT 56
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3911
Mailing Address - Country:US
Mailing Address - Phone:510-387-5113
Mailing Address - Fax:
Practice Address - Street 1:1459 CURCI DR APT 56
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3911
Practice Address - Country:US
Practice Address - Phone:510-387-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist