Healthcare Provider Details

I. General information

NPI: 1053257899
Provider Name (Legal Business Name): JONATHAN ALEXANDER TUSCANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

IV. Provider business mailing address

853 E 4TH PL APT 102
MESA AZ
85203-7155
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax:
Mailing address:
  • Phone: 435-256-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: