Provider Demographics
NPI:1609162049
Name:ASZTALOS, MANUELA LOREDANA (MD)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:LOREDANA
Last Name:ASZTALOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANUELA
Other - Middle Name:
Other - Last Name:MOSCALIUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14275 N 87TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3696
Mailing Address - Country:US
Mailing Address - Phone:480-905-8485
Mailing Address - Fax:480-591-9009
Practice Address - Street 1:5206 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:480-771-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.066962207N00000X
WI69468207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080550Medicaid