Individual
MARISSA DACRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
360 HUNTINGTON AVE, BOSTON, MA 02115-5005
(617) 373-2000
Mailing address
5050 WASHINGTON ST APT 216, WEST ROXBURY, MA 02132-4744
(203) 908-5196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA01647
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/31/2022
Last updated
08/28/2024
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