Provider Demographics
NPI:1295799674
Name:RACITI, MARC C (PA-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:C
Last Name:RACITI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 E SAN BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2430
Mailing Address - Country:US
Mailing Address - Phone:808-457-5807
Mailing Address - Fax:602-867-9853
Practice Address - Street 1:2451 E BASELINE RD STE 430
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2473
Practice Address - Country:US
Practice Address - Phone:602-313-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical