Healthcare Provider Details

I. General information

NPI: 1700018892
Provider Name (Legal Business Name): MARCELLA BAKER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850N CENTRAL AVE 1600
PHOENIX AZ
85004-4633
US

IV. Provider business mailing address

1850N CENTRAL AVE 1600
PHOENIX AZ
85004-4633
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax: 602-262-8890
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAZ1447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: