Provider Demographics
NPI:1861673998
Name:HINOJOSA, MARCELO WILFRAN (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCELO
Middle Name:WILFRAN
Last Name:HINOJOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:BOX 356410
Mailing Address - Street 2:1959 NE PACIFIC STREET
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6410
Mailing Address - Country:US
Mailing Address - Phone:206-221-7148
Mailing Address - Fax:206-543-8136
Practice Address - Street 1:101 THE CITY DR S BLDG 22C
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94553208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8900974Medicare UPIN