Healthcare Provider Details

I. General information

NPI: 1538400692
Provider Name (Legal Business Name): ALAINA ANNE VACCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 100
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

1 N 1ST ST FL 7
PHOENIX AZ
85004-2357
US

V. Phone/Fax

Practice location:
  • Phone: 602-704-2345
  • Fax: 602-704-2399
Mailing address:
  • Phone: 602-704-2345
  • Fax: 602-704-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5323
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: