Individual
MARISSA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(602) 344-5726
Mailing address
2929 E THOMAS RD, PHOENIX, AZ 85016-8034
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10967
AZ
Other
Enumeration date
11/20/2024
Last updated
02/13/2025
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