Provider Demographics
NPI:1659844694
Name:MAZZUCA, ASHLEY (SONOGRAPHER)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MAZZUCA
Suffix:
Gender:F
Credentials:SONOGRAPHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 CANCUN CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8606
Mailing Address - Country:US
Mailing Address - Phone:970-361-4106
Mailing Address - Fax:
Practice Address - Street 1:2703 CANCUN CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8606
Practice Address - Country:US
Practice Address - Phone:970-361-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2404882085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound