Provider Demographics
NPI:1467419937
Name:CITY, REGAN BUZZELLI (PAC)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:BUZZELLI
Last Name:CITY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:REGAN
Other - Middle Name:CHRISTINE
Other - Last Name:BUZZELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 3114
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85271-3114
Mailing Address - Country:US
Mailing Address - Phone:480-425-5063
Mailing Address - Fax:480-425-5010
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:#130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-425-5000
Practice Address - Fax:480-425-5010
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642464Medicaid
P55734Medicare UPIN
AZ108950Medicare PIN
AZ642464Medicaid