Provider Demographics
NPI:1811506074
Name:ARIETA, MARCELLA (LMT CES)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:ARIETA
Suffix:
Gender:F
Credentials:LMT CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 E FAIRMOUNT ST # 1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3711
Mailing Address - Country:US
Mailing Address - Phone:520-443-1190
Mailing Address - Fax:
Practice Address - Street 1:1625 W INA RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1975
Practice Address - Country:US
Practice Address - Phone:520-989-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-16679225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist