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Marietta Formoso Light, NP-C
Obstetrics & Gynecology Nurse Practitioner in Clovis, California
NPI 1750368650

Marietta Formoso Light is a Obstetrics & Gynecology Nurse Practitioner based in Fresno, CA and is specialized in Obstetrics & Gynecology. Marietta Formoso Light practices in Clovis, CA and has the professional credentials of NP-C. The NPI Number for Marietta Formoso Light is 1750368650 and holds a License No. 6030 (California).

The current practice location address for Marietta Formoso Light is 782 Medical Center Dr E Ste 212, Clovis, CA and can be reached out via phone at 559-451-3676 and via fax at 559-451-3680.

Location: 782 Medical Center Dr E Ste 212, Clovis, CA, 93721-1431
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Provider Profile Details
NPI Number
1750368650
Provider Name
Marietta Formoso Light
Credential
NP-C
Provider Entity Type
Individual
Gender
Female
Address
782 Medical Center Dr E Ste 212, Clovis, CA, 93721-1431
Phone Number
559-451-3676
Fax Number
559-451-3680
Provider Enumeration Date
12/30/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
302503 01 CA REGISTERED NURSE LIC
6030 01 CA NURSE PRACTITIONER FURN
institution
Provider Business Practice Location Address Details
Address
782 Medical Center Dr E Ste 212
City
State
Zip
93611-6889
Phone Number
559-451-3676
Fax Number
559-451-3680
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Provider Business Mailing Address Details
Address
782 Medical Center Dr E Ste 212
City
State
Zip
93611-6889
Phone Number
559-451-3676
Fax Number
559-451-3680
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
6030 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Women's Health
Taxonomy
License No.
6030 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Obstetrics & Gynecology
Taxonomy
License No.
6030 (California)
Definition
Definition to come...
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