Provider Demographics
NPI:1386406866
Name:MARCELO, SANDRA MAREY
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAREY
Last Name:MARCELO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 GLADSTONE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5126
Mailing Address - Country:US
Mailing Address - Phone:925-431-2144
Mailing Address - Fax:
Practice Address - Street 1:2240 GLADSTONE DR STE 4
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5126
Practice Address - Country:US
Practice Address - Phone:925-431-2144
Practice Address - Fax:925-431-1234
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program