Healthcare Provider Details

I. General information

NPI: 1912983008
Provider Name (Legal Business Name): DEBBIE SUNSHINE MASCOVICH PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 N 19TH AVE STE 121
PHOENIX AZ
85015-2901
US

IV. Provider business mailing address

PO BOX 47328
PHOENIX AZ
85068-7328
US

V. Phone/Fax

Practice location:
  • Phone: 602-433-1822
  • Fax: 602-246-7060
Mailing address:
  • Phone: 970-778-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number763
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: