Healthcare Provider Details

I. General information

NPI: 1235055831
Provider Name (Legal Business Name): MARCELLE CARRILHO ALECRIM PACHECO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 S BASCOM AVE STE 100
CAMPBELL CA
95008-5541
US

IV. Provider business mailing address

230 BATES AVE
SAINT PAUL MN
55106-5504
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone: 443-603-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: