Provider Demographics
NPI:1437267390
Name:VELA AQUINO, MARCELO F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:F
Last Name:VELA AQUINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCELO
Other - Middle Name:F
Other - Last Name:VELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MSCR
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-5452
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161300207RG0100X
MN62770207RG0100X
AZ49249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267972Medicaid
TX8L25477Medicare PIN
SCAA0518Medicare ID - Type Unspecified
SC267972Medicaid