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General NPI Number Information
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NPI Number | 1689178519
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Entity Type | Individual
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Provider Name | MARISA CHRISTINA CORNEJO MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 14155 N 83RD AVE
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City | PEORIA
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State | AZ
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Zip | 85381-5639
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Country | US
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Telephone | 623-271-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 14155 N 83RD AVE STE 138 BLDG 6
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City | PEORIA
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State | AZ
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Zip | 85381-5639
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Country | US
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Telephone | 623-271-8666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 77368
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 77368
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License Number State | AZ
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