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Individual

MARISSA MASTROCOLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
450 BROADWAY ST # MC6342, REDWOOD CITY, CA 94063-3132
(650) 721-1836
Mailing address
450 BROADWAY ST # MC6342, REDWOOD CITY, CA 94063-3132
(650) 721-1836

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101287702
VA
390200000X
Student in an Organized Health Care Education/Training Program
CA

Other

Enumeration date
03/23/2019
Last updated
12/02/2025
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