MEDICARE: ASHLEY MAZZUCA SONOGRAPHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	240488	CO

General Provider Information

NPI Number	:	1659844694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MAZZUCA SONOGRAPHER

Provider Business Mailing Address
First Line	:	2703 CANCUN CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8606
Country	:	US
Telephone Number	:	970-361-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 CANCUN CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8606
Country	:	US
Telephone Number	:	970-361-4106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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