Provider Demographics
NPI:1629027248
Name:PASCUA, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:PASCUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:BUILDING 5, SUITE 502
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:623-466-6339
Mailing Address - Fax:623-466-6338
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:BUILDING 5, SUITE 502
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:623-466-6339
Practice Address - Fax:623-466-6338
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374067Medicaid
AZ374067Medicaid