Healthcare Provider Details

I. General information

NPI: 1457648107
Provider Name (Legal Business Name): ENGELBERT MARRERO ARNP PMHNP-BC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 02/08/2022
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 W BELL RD STE 101114
SURPRISE AZ
85374-3214
US

IV. Provider business mailing address

4310 W PHALEN DR
NEW RIVER AZ
85087-5986
US

V. Phone/Fax

Practice location:
  • Phone: 623-269-4870
  • Fax: 623-269-4871
Mailing address:
  • Phone: 602-718-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRNP252593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: