Provider Demographics
NPI:1265571665
Name:CUCCHETTI, HEATHER ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE
Last Name:CUCCHETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4400 N 32ND ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3961
Mailing Address - Country:US
Mailing Address - Phone:602-956-9595
Mailing Address - Fax:602-956-3232
Practice Address - Street 1:4400 N 32ND ST STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3961
Practice Address - Country:US
Practice Address - Phone:602-956-9595
Practice Address - Fax:602-956-3232
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ754844Medicaid
AZZ156811OtherMEDICARE PIN- PIMA COUNTY
AZZ156810OtherMEDICARE UPIN- PINAL COUNTY
AZZ156811OtherMEDICARE PIN- PIMA COUNTY