MEDICARE: DULCE C USECHE DE MUJICA PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9700	AZ

General Provider Information

NPI Number	:	1427768480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DULCE C USECHE DE MUJICA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1345 E MAIN ST STE 100
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-8950
Country	:	US
Telephone Number	:	480-264-3711
Fax Number	:	877-725-3934

Provider Business Practice Location Address
First Line	:	1345 E MAIN ST STE 100
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-8950
Country	:	US
Telephone Number	:	480-264-3711
Fax Number	:	877-725-3934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/11/2025

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