MEDICARE: DR. ASHLEY ASCENCIO D.O.

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	208D00000X	General Practice Physician	2012029298	MO
2	208D00000X	General Practice Physician	05-35969	KS

General Provider Information

NPI Number	:	1801185277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY ASCENCIO D.O.

Provider Business Mailing Address
First Line	:	6606 RAINBOW AVE
Second Line	:
City	:	MISSION HILLS
State	:	KS
Zip	:	66208-1968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 RAINBOW AVE
Second Line	:
City	:	MISSION HILLS
State	:	KS
Zip	:	66208-1968
Country	:	US
Telephone Number	:	949-294-8420
Fax Number	:

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	12/01/2015

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