Provider Demographics
NPI:1588616734
Name:MARIANO, ELEANOR CONCEPCION (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:CONCEPCION
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15215 N KIERLAND BLVD UNIT 438
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8220
Mailing Address - Country:US
Mailing Address - Phone:480-945-2494
Mailing Address - Fax:480-323-2699
Practice Address - Street 1:8575 E PRINCESS DR STE A215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-945-2494
Practice Address - Fax:480-323-2699
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109131Medicare PIN
AZH32846Medicare UPIN