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General NPI Number Information
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NPI Number | 1629158464
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Entity Type | Individual
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Provider Name | JOSEPH NO MIDDLE NAME MARZUCCO P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 406 SE 131ST AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98683-4031
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Country | US
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Telephone | 360-253-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 4421 NE ST JOHNS RD
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City | VANCOUVER
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State | WA
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Zip | 98661-2573
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Country | US
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Telephone | 360-695-9922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10000481
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License Number State | WA
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