Provider Demographics
NPI:1619109683
Name:MSMANCINA ASSOCIATES ARIZONA, PLLC
Entity Type:Organization
Organization Name:MSMANCINA ASSOCIATES ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-390-4934
Mailing Address - Street 1:3610 N 44TH ST
Mailing Address - Street 2:101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6059
Mailing Address - Country:US
Mailing Address - Phone:602-685-9500
Mailing Address - Fax:602-685-9595
Practice Address - Street 1:5616 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8813
Practice Address - Country:US
Practice Address - Phone:866-390-4934
Practice Address - Fax:866-307-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421587207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A02469Medicare UPIN