Provider Demographics
NPI:1902962954
Name:CRITELLI, MARGUERITE JOANNA (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:JOANNA
Last Name:CRITELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WESTCLIFF DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5505
Mailing Address - Country:US
Mailing Address - Phone:949-646-3376
Mailing Address - Fax:949-646-3303
Practice Address - Street 1:1901 WESTCLIFF DR STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5505
Practice Address - Country:US
Practice Address - Phone:949-646-3376
Practice Address - Fax:949-646-3303
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076233207N00000X
TXS6378207N00000X
CAG76233207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02214Medicare UPIN
G76233Medicare ID - Type Unspecified