Individual provider · NPI-1

Marissa Marie Frutos- Dominguez

Rehabilitation Practitioner · Mountain View, CA

NPI number1275409724
StatusActive
Last updated in NPPESOct 24, 2025

Details

NPI
1275409724
Entity type
Individual (NPI-1)
Name
Marissa Marie Frutos- Dominguez
Sex
Female
Sole proprietor
No
Enumeration date
Oct 13, 2025
Certification date
Oct 13, 2025
Last updated
Oct 24, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225400000X Rehabilitation Practitioner––Yes

Practice location

1503 Grant Rd Ste 110
Mountain View, CA 94040-3270

Phone 650-484-1213 · Fax 408-642-6052

Mailing address

1922 The Alameda
Suite 316
San Jose, CA 95126

Phone 408-261-7777 · Fax 408-642-6052

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