Provider Demographics
NPI:1689897761
Name:MARINELLI, DERRICK V (MD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:V
Last Name:MARINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1950 SUNNYCREST DR
Mailing Address - Street 2:#3400
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3638
Mailing Address - Country:US
Mailing Address - Phone:714-879-2410
Mailing Address - Fax:714-879-5340
Practice Address - Street 1:1950 SUNNYCREST DR
Practice Address - Street 2:#3400
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-879-2410
Practice Address - Fax:714-879-5340
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG59971208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0011581OtherMEDI CAL GROUP
CA1851498133OtherGROUP NPI
CA05D0552498OtherCLIA
CAYYY49655YOtherBLUE SHIELD
CA05D0684380OtherCLIA
05D0977537OtherCLIA
CAG59971OtherPHYS LICENSE
CAG59971OtherMEDI CAL RENDERING
CAW450AMedicare PIN
CAGR0011581OtherMEDI CAL GROUP
CAW450Medicare PIN
CAWG59971BMedicare PIN
CA05D0552498OtherCLIA
CAYYY49655YOtherBLUE SHIELD
CAW450BMedicare PIN