Individual
CHARLES MARISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1126 N GRAND AVE, SUITE D, COVINA, CA 91724-1551
(626) 967-1667
(626) 967-6027
Mailing address
711 W BLAINE STREET, SUITE C/D, RIVERSIDE, CA 92507
(951) 955-2233
(951) 955-2233
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
06/14/2007
Last updated
04/30/2025
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