Healthcare Provider Details

I. General information

NPI: 1922270339
Provider Name (Legal Business Name): JOEL P. MASCARO, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 N 90TH ST SUITE 114
SCOTTSDALE AZ
85258-5099
US

IV. Provider business mailing address

11681 E BELLA VISTA DR
SCOTTSDALE AZ
85259-6360
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-3313
  • Fax:
Mailing address:
  • Phone: 602-431-1152
  • Fax: 602-431-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3250
License Number StateAZ

VIII. Authorized Official

Name: DR. JOEL P MASCARO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 602-431-1152