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NPI Code Detail

MEDICARE: MR. EUGENE F. MARCELO BS

MEDICARE: MR. EUGENE F. MARCELO BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1912044785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EUGENE F. MARCELO BS
Provider Business Mailing Address
First Line : 2495 W MARCH LN
Second Line : STE 125
City : STOCKTON
State : CA
Zip : 95207-8251
Country : US
Telephone Number : 209-465-1080
Fax Number : 209-465-2709
Provider Business Practice Location Address
First Line : 2495 W MARCH LN
Second Line : STE 125
City : STOCKTON
State : CA
Zip : 95207-8224
Country : US
Telephone Number : 209-465-1080
Fax Number : 209-465-2709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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