Provider Demographics
NPI:1033259338
Name:MUTASCIO, MICHELE (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MUTASCIO
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 N GRANITE REEF RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4921
Mailing Address - Country:US
Mailing Address - Phone:602-380-4995
Mailing Address - Fax:
Practice Address - Street 1:8390 E VIA DE VENTURA
Practice Address - Street 2:SUITE F114
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3190
Practice Address - Country:US
Practice Address - Phone:480-998-7501
Practice Address - Fax:480-998-5503
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0469171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist