Provider Demographics
NPI:1548452972
Name:CIPOLLO, MARIE MENDOZA (DC)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MENDOZA
Last Name:CIPOLLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770
Mailing Address - Country:US
Mailing Address - Phone:626-280-9968
Mailing Address - Fax:
Practice Address - Street 1:3925 NORTH FIRST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-888-0180
Practice Address - Fax:520-888-0181
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0100223111N00000X
CA16899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5274Medicare UPIN