Provider Demographics
NPI:1114651551
Name:MASCORRO, JOSHUA (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MASCORRO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4682
Mailing Address - Country:US
Mailing Address - Phone:281-309-7246
Mailing Address - Fax:
Practice Address - Street 1:2240 GULF FWY S # 1
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5143
Practice Address - Country:US
Practice Address - Phone:832-505-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered