Provider Demographics
NPI:1760639116
Name:FANUCCHI, ANGELA (BHS SPECIALIST)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:FANUCCHI
Suffix:
Gender:F
Credentials:BHS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4108
Mailing Address - Country:US
Mailing Address - Phone:480-969-3800
Mailing Address - Fax:
Practice Address - Street 1:924 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4108
Practice Address - Country:US
Practice Address - Phone:480-969-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist