Healthcare Provider Details

I. General information

NPI: 1295799674
Provider Name (Legal Business Name): MARC C RACITI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 430
GILBERT AZ
85234-2473
US

IV. Provider business mailing address

8315 E SAN BERNARDO DR
SCOTTSDALE AZ
85258-2430
US

V. Phone/Fax

Practice location:
  • Phone: 602-313-4391
  • Fax:
Mailing address:
  • Phone: 808-457-5807
  • Fax: 602-867-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: