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General NPI Number Information
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NPI Number | 1801906771
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Entity Type | Individual
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Provider Name | MARCIA MASTRIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 2040 W BETHANY HOME RD STE 102
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City | PHOENIX
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State | AZ
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Zip | 85015-2473
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Country | US
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Telephone | 602-368-8800
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Fax | 602-368-8801
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Provider Business Mailing Address
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Address Line | 2040 W BETHANY HOME RD STE 102
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City | PHOENIX
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State | AZ
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Zip | 85015-2473
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Country | US
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Telephone | 602-236-8800
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Fax | 602-368-8801
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 31029
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License Number State | AZ
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