Provider Demographics
NPI:1881576478
Name:HODGES, MARISSA ALEXANDRA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ALEXANDRA
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12014 3RD ST APT B
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2744
Mailing Address - Country:US
Mailing Address - Phone:909-705-2328
Mailing Address - Fax:
Practice Address - Street 1:12014 3RD ST APT B
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2744
Practice Address - Country:US
Practice Address - Phone:909-705-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA752362164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse