MARIETTA FORMOSO LIGHT (NPI# 1750368650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750368650 |
| Entity Type | Individual |
| Full Name | MARIETTA FORMOSO LIGHT |
| Credential | NP-C |
| Practice Address |
782 Medical Center Dr E Ste 212 Clovis CA 93611-6889 |
| Mailing Address |
2625 E Divisadero St Fresno CA 93721-1431 |
| Practice Telephone | 5594513676 |
| Practice Fax Number | 5594513680 |
| Mailing Telephone | 5594432682 |
| Mailing Fax Number | 5594432681 |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-10-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
6030 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
6030 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
6030 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | REGISTERED NURSE LIC | 302503 | 01 |
| CA | NURSE PRACTITIONER FURN | 6030 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 782 Medical Center Dr E # 212, Clovis, CA 936116889 | 5594513676 | 5594513680 |
| Street Address |
782 MEDICAL CENTER DR E STE 212 |
| City | CLOVIS |
| State | CA |
| Zip Code | 93611-6889 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669985974 | Iriana Jaime Sadaghiani | Nurse Practitioner | 782 Medical Center Dr E Ste 212, Clovis, CA 93611-6889 | 2017-11-08 |
| 1104168756 | Alexandra Holly Freeman | Obstetrics & Gynecology | 782 Medical Center Dr E Ste 212, Clovis, CA 93611-6889 | 2013-03-21 |
| 1942568431 | Ragini Sastry | Obstetrics & Gynecology | 782 Medical Center Dr E Ste 212, Clovis, CA 93611-6889 | 2012-05-02 |
| 1255599130 | Dennis Charles Desimone | Obstetrics & Gynecology | 782 Medical Center Dr E Ste 212, Clovis, CA 93611-6889 | 2008-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033773122 | Mao Thao | Pharmacist | 2133 Shaw Avenue, Clovis, CA 93611 | 2019-04-24 |
| 1326506098 | Lauren Moriah Horsley | Speech-Language Pathologist | 650 W. Alluvial Ave., Clovis, CA 93611 | 2019-03-12 |
| 1780171223 | Alamos Care | Skilled Nursing Facility | 2193 Alamos Ave, Clovis, CA 93611 | 2018-04-19 |
| 1346612215 | Aimee Rasch | Occupational Therapy Assistant | 650 West Alluvial Avenue, Clovis, CA 93611 | 2015-10-30 |
| 1356778302 | Jonathan Crosby | Physician Assistant | 729 N Medical Center Drive West Suite 101, Clovis, CA 93611 | 2013-10-07 |
| 1093142697 | Stacey Melissa Montes | Nurse Practitioner | 729 N Medical Ctr Dr West, Suite 205, Clovis, CA 93611 | 2013-09-27 |
| 1538594163 | Carly Bren Lepp | Physician Assistant | 2006 Shaw Avenue, Clovis, CA 93611 | 2013-09-13 |
| 1811246150 | Vishal Arya | Pharmacist | 2518 Austin Ave, Clovis, CA 93611 | 2012-08-31 |
| 1669757209 | Kiran V Atwal | Pharmacist | 1815 Herndon Ave--walgreens, Clovis, CA 93611 | 2011-10-14 |
| 1952615957 | Weight Away | Nutritionist | 1895 Herndon Ave, Suite 105, Clovis, CA 93611 | 2010-08-02 |
| Find all providers in zip 93611 | ||||
| Taxonomy Code | 363LX0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Obstetrics & Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356680623 | Dani Ellen | Nurse Practitioner | 722 Medical Center Dr E Ste 105, Clovis, CA 93611-6810 | 2013-02-06 |
| 1366439606 | Michelle Marie Harmon | Nurse Practitioner | 208 W Casablanca Cannon Afb, Bldg 1400 27 Medical Group, Clovis, NM 88103-5014 | 2005-10-03 |
| 1821492638 | Melissa Ashley Sprinkle | Nurse Practitioner | 2000 W 21st St, Suite A-1, Clovis, NM 88101-4087 | 2014-10-22 |
| 1235295825 | Anne Louise Schattke | Nurse Practitioner | 2071 Herndon Ave, Obgyn, Clovis, CA 93611-6101 | 2006-12-28 |
| 1609882570 | Marina L Johnston | Nurse Practitioner | 208 W Casablanca, 27 Medical Group Bldg 1400 Cannon Afb, Clovis, NM 88103-5014 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548819964 | Myra Sepulveda | Nurse Practitioner | 1700 Lombard St Ste 110, Oxnard, CA 93030-8288 | 2019-09-09 |
| 1639641699 | Zahra Jeylani Nur | Nurse Practitioner | 15101 Spectrum, Irvine, CA 92618-3426 | 2018-12-31 |
| 1518486125 | Patty Montoya | Nurse Practitioner | 1026 Felder St, Gardena, CA 90248-3348 | 2017-09-14 |
| 1902357817 | Alexandria Ludlow | Nurse Practitioner | 350 John Muir Pkwy Ste 205, Brentwood, CA 94513-5193 | 2016-10-17 |
| 1477922102 | Vanessa Domush | Nurse Practitioner | 845 E. Willow St, Signal Hill, CA 90755 | 2015-09-23 |
| 1174999015 | Kristina Hagopian | Nurse Practitioner | 8920 Wilshire Blvd Ste 525, Beverly Hills, CA 90211-1968 | 2015-08-14 |
| 1639553076 | Pacific Women's Healthcare Associates | Nurse Practitioner | 500 Superior Ave Ste 310, Newport Beach, CA 92663-3609 | 2015-07-15 |
| 1548655921 | Trudi J Petersen | Nurse Practitioner | 1700 Shattuck Ave # 75, Berkeley, CA 94709-3402 | 2015-04-01 |
| 1932590775 | Samah Shahzya Kureshi | Nurse Practitioner | 2619 Vanderbilt Ln Unit B, Redondo Beach, CA 90278-3318 | 2015-02-16 |
| 1346645801 | Norma Nix | Nurse Practitioner | 22423 Chase St, West Hills, CA 91304-3321 | 2014-10-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.