Provider Demographics
NPI:1497329320
Name:MARISCAL, MARCO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:MARISCAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S DOBSON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6490
Mailing Address - Country:US
Mailing Address - Phone:602-617-1514
Mailing Address - Fax:
Practice Address - Street 1:2222 S DOBSON RD STE 301
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6490
Practice Address - Country:US
Practice Address - Phone:480-581-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional