Provider Demographics
NPI:1124202247
Name:MARELLI, MADHURI (PA)
Entity Type:Individual
Prefix:MS
First Name:MADHURI
Middle Name:
Last Name:MARELLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADHURI
Other - Middle Name:LINKER
Other - Last Name:CAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2302 AMSTEL LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2601
Mailing Address - Country:US
Mailing Address - Phone:760-295-5392
Mailing Address - Fax:
Practice Address - Street 1:2302 AMSTEL LN
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2601
Practice Address - Country:US
Practice Address - Phone:760-295-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16588363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical