Provider Demographics
NPI:1790902781
Name:MARCELO, ELIZABETH DONATO (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DONATO
Last Name:MARCELO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4003
Mailing Address - Country:US
Mailing Address - Phone:562-860-1805
Mailing Address - Fax:
Practice Address - Street 1:11828 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4003
Practice Address - Country:US
Practice Address - Phone:562-860-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice