Provider Demographics
NPI:1861602021
Name:MARRACINO, RICHELLE (MD)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:MARRACINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7100
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0100
Mailing Address - Country:US
Mailing Address - Phone:909-537-7444
Mailing Address - Fax:909-537-7027
Practice Address - Street 1:5500 UNIVERSITY PARKWAY
Practice Address - Street 2:CSUSB STUDENT HEALTH CENTER
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407
Practice Address - Country:US
Practice Address - Phone:909-537-7444
Practice Address - Fax:909-537-7027
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67463207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine