Healthcare Provider Details

I. General information

NPI: 1093938128
Provider Name (Legal Business Name): JANET MARIE MARINELLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET MARIE IOGA PA-C

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CAPRI BLVD STE 102
LAKE HAVASU CITY AZ
86403-5661
US

IV. Provider business mailing address

4800 N 22ND ST STE 210
PHOENIX AZ
85016-4963
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-1000
  • Fax: 602-508-4830
Mailing address:
  • Phone: 602-955-1000
  • Fax: 602-508-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3604
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3604
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3604
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: