Healthcare Provider Details

I. General information

NPI: 1619414497
Provider Name (Legal Business Name): MARCELO PANDO RIGAL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD ROOM 1-253
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

5777 E MAYO BLVD ROOM 1-253
PHOENIX AZ
85054-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-4103
  • Fax:
Mailing address:
  • Phone: 480-342-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDRK00000041
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDI47004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: