Light, Marietta Formoso

Light, Marietta Formoso is an individual health care provider with primary practice located at 782 Medical Center Dr E Ste 212 , Clovis CA 93611-6889. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Women's Health, Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology. Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology is her primary health care specialty. Light, Marietta Formoso can be contacted via phone (559) 451-3676.

Contact Information

Primary practice address
782 Medical Center Dr E Ste 212 Clovis CA 93611-6889
Phone: (559) 451-3676
Fax: (559) 451-3680
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 6030 California
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 6030 California
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X 6030 California

Profile Details

NPI number 1750368650
LBN Legal business name Light, Marietta Formoso
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 30th, 2005
Last updated Oct 8th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750368650 NPPES
California Other 302503 REGISTERED NURSE LIC
California Other 6030 REGISTERED NURSE LIC

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