1457648107 NPI number — MR. ENGELBERT MARRERO ARNP PMHNP-BC, RN

Table of content: MR. ENGELBERT MARRERO ARNP PMHNP-BC, RN (NPI 1457648107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457648107 NPI number — MR. ENGELBERT MARRERO ARNP PMHNP-BC, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRERO
Provider First Name:
ENGELBERT
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ARNP PMHNP-BC, RN
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:
1457648107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4310 W PHALEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW RIVER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85087-5986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-718-7637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15015 W BELL RD STE 101114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-269-4870
Provider Business Practice Location Address Fax Number:
623-269-4871
Provider Enumeration Date:
07/01/2011

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: 363LP0808X , with the licence number:  RNP252593 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252593 . This is a "ARIZONA BOARD OF NURSING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com