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Contact Information

DEREK MARRONGELLE, DACM, L.AC., CCN
16421 N TATUM BLVD STE 210
PHOENIX, AZ85032-3457
 Phone: 570-617-9005
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Acupuncturist

171100000X
 

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for DEREK MARRONGELLE · (Male)

NPI Number 1417581539
Status Active
Credentials DACM, L.AC., CCN
Entity Individual
Enumeration date 02/27/2020
Last updated 08/25/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • License # 5063
  • AZ License # LAC-010133
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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