Provider Demographics
NPI:1568950640
Name:MARCELO, VANESSA (DPM)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:MARCELO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:MARCELO
Other - Last Name:BODDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1701 S CAGE BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6459
Mailing Address - Country:US
Mailing Address - Phone:956-702-7054
Mailing Address - Fax:956-702-7650
Practice Address - Street 1:1701 S CAGE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6459
Practice Address - Country:US
Practice Address - Phone:956-702-7054
Practice Address - Fax:956-702-7650
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3100213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery