Provider Demographics
NPI:1134303837
Name:MARCELO, DARYL R (DO)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:R
Last Name:MARCELO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARYL
Other - Middle Name:
Other - Last Name:ROJSIRIVAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14239 W BELL RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2469
Mailing Address - Country:US
Mailing Address - Phone:623-876-9983
Mailing Address - Fax:623-876-9984
Practice Address - Street 1:14239 W BELL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2469
Practice Address - Country:US
Practice Address - Phone:623-876-9983
Practice Address - Fax:623-876-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4775OtherAZ LICENSE