Provider Demographics
NPI:1164527396
Name:FRAUSTO, TRACY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:FRAUSTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16455
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-6455
Mailing Address - Country:US
Mailing Address - Phone:480-615-2010
Mailing Address - Fax:
Practice Address - Street 1:7400 S POWER RD
Practice Address - Street 2:SUITE 140
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9281
Practice Address - Country:US
Practice Address - Phone:480-615-2010
Practice Address - Fax:480-279-1189
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88268208000000X
AZ36504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218244Medicaid