Individual
DEREK MARRONGELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DACM, L.AC., CCN
Contact information
Practice address
16421 N TATUM BLVD STE 210, PHOENIX, AZ 85032-3457
(570) 617-9005
Mailing address
113 PINE CREEK DR, ORWIGSBURG, PA 17961-9135
(570) 617-9005
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
5063
—
171100000X
Acupuncturist
Primary
LAC-010133
AZ
Other
Enumeration date
02/27/2020
Last updated
08/25/2020
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