Provider Demographics
NPI:1407981319
Name:MARCILI, MARIZA DEL CARMEN (APN)
Entity Type:Individual
Prefix:
First Name:MARIZA
Middle Name:DEL CARMEN
Last Name:MARCILI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545N 36TH ST 126
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3456
Mailing Address - Country:US
Mailing Address - Phone:602-824-9309
Mailing Address - Fax:602-916-1086
Practice Address - Street 1:4545N 36TH ST 126
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3456
Practice Address - Country:US
Practice Address - Phone:602-824-9309
Practice Address - Fax:602-916-1086
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005463Medicaid
AZ427126Medicaid
AZ427126Medicaid
AZZ145257Medicare PIN