Healthcare Provider Details

I. General information

NPI: 1760887194
Provider Name (Legal Business Name): ALLISON JINGCO MARCELO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E PALOMAR ST
CHULA VISTA CA
91911-6974
US

IV. Provider business mailing address

894 BRYCE CANYON AVE
CHULA VISTA CA
91914-3602
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-6500
  • Fax:
Mailing address:
  • Phone: 619-934-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: