Provider Demographics
NPI:1609863521
Name:ASCANIO, MARIA I (MSMT(ASCP))
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:ASCANIO
Suffix:
Gender:F
Credentials:MSMT(ASCP)
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 801224
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1224
Mailing Address - Country:US
Mailing Address - Phone:787-856-4463
Mailing Address - Fax:787-856-4081
Practice Address - Street 1:CARR 371 KM. 1.7
Practice Address - Street 2:BO. ALMACIGO BAJO
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-4463
Practice Address - Fax:787-856-4081
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1031291U00000X
246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30950Medicare ID - Type Unspecified