1205889151 NPI number — DR. MARCELO TRINIDAD-CARRILLO PH.D.

Table of content: DR. MARCELO TRINIDAD-CARRILLO PH.D. (NPI 1205889151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205889151 NPI number — DR. MARCELO TRINIDAD-CARRILLO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRINIDAD-CARRILLO
Provider First Name:
MARCELO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205889151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 930406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53593-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-444-8619
Provider Business Mailing Address Fax Number:
608-270-9731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5930 SEMINOLE CENTRE CT STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-270-1800
Provider Business Practice Location Address Fax Number:
608-270-9731
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2210057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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