Provider Demographics
NPI:1851860316
Name:MARSEILLE, EMMANUEL (CSA, MD, PA)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:MARSEILLE
Suffix:
Gender:M
Credentials:CSA, MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14877 N 145TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4765
Mailing Address - Country:US
Mailing Address - Phone:561-900-6083
Mailing Address - Fax:
Practice Address - Street 1:6710 N 47TH AVE STE 8
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-4111
Practice Address - Country:US
Practice Address - Phone:623-872-3077
Practice Address - Fax:480-919-1166
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9583363A00000X, 363A00000X
NJNJDCATEMP-000540208D00000X
4726246ZC0007X
NJNJDCATEMP-000512363A00000X
PR000201-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant