Individual
DR. DERRICK V MARINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1950 SUNNYCREST DR, #3400, FULLERTON, CA 92835-3638
(714) 879-2410
(714) 879-5340
Mailing address
1950 SUNNYCREST DR, #3400, FULLERTON, CA 92835-3638
(714) 879-2410
(714) 879-5340
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G59971
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0552498
CLIA
CA
01
—
05D0684380
CLIA
CA
01
—
05D0977537
CLIA
—
01
—
1851498133
GROUP NPI
CA
01
—
G59971
PHYS LICENSE
CA
01
—
GR0011581
MEDI CAL GROUP
CA
01
—
YYY49655Y
BLUE SHIELD
CA
Enumeration date
04/10/2007
Last updated
12/01/2021
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