Provider Demographics
NPI:1588774640
Name:GOCHA, MARINA (DC)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GOCHA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:GOCHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:846 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4422
Mailing Address - Country:US
Mailing Address - Phone:650-321-7776
Mailing Address - Fax:650-321-1161
Practice Address - Street 1:846 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4422
Practice Address - Country:US
Practice Address - Phone:650-321-7776
Practice Address - Fax:650-321-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0236550Medicare ID - Type Unspecified