Provider Demographics
NPI:1356474506
Name:URSO, REBECCA A (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:URSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15816 E. EAGLE EYE PL.
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268
Mailing Address - Country:US
Mailing Address - Phone:480-816-5979
Mailing Address - Fax:
Practice Address - Street 1:4550 E. BELL ROAD
Practice Address - Street 2:#114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9342
Practice Address - Country:US
Practice Address - Phone:602-996-6668
Practice Address - Fax:602-971-8877
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2859AZ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical