Healthcare Provider Details

I. General information

NPI: 1851860316
Provider Name (Legal Business Name): EMMANUEL MARSEILLE CSA, MD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S MCCLINTOCK DR STE 140
TEMPE AZ
85282-7375
US

IV. Provider business mailing address

14877 N 145TH DR
SURPRISE AZ
85379-4765
US

V. Phone/Fax

Practice location:
  • Phone: 480-851-6309
  • Fax: 573-240-9791
Mailing address:
  • Phone: 561-900-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9583
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: