Derek Marrongelle, DACM, L.AC., CCN

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

LAC-010133 Issued in AZ

Practice address

16421 N Tatum Blvd Ste 210
Phoenix, AZ 85032-3457

Phone

(570) 617-9005

NPI assigned

Feb 27, 2020

Last updated

Aug 25, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Energized Fitness, LLC

  dba Energized Health Solutions

  • Acupuncturist
  • Phoenix, AZ
  • NPI 1508490624
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1417581539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 PINE CREEK DR",
            "city": "ORWIGSBURG",
            "state": "PA",
            "postal_code": "179619135",
            "telephone_number": "570-617-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16421 N TATUM BLVD STE 210",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323457",
            "telephone_number": "570-617-9005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 Pine Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Orwigsburg",
            "state": "PA",
            "postal_code": "179619135",
            "country_code": "US",
            "telephone_number": "570-617-9005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARRONGELLE",
        "first_name": "DEREK",
        "credential": "DACM, L.AC., CCN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": "5063",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "AZ",
            "license": "LAC-010133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Marrero Respeto, MD
• Adriana Gissel Marrero
• Dawn Marrero, LCSW
• Sheryl L Marrero, NP
• Melissa Marriott, SLPA
• Madison Marrujo
• Jean K Marseille
• Kim Marseilles, O.T.
• Catrina Marsh, FNP-C
• Meghan Marsh

• Acupuncturist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Acupuncturist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.