Provider Demographics
NPI:1780451765
Name:RANGEL, MARK A (PA-C)
Entity type:Individual
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First Name:MARK
Middle Name:A
Last Name:RANGEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2617
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:888-316-1686
Practice Address - Street 1:287 E HUNT HWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:888-316-1686
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2025-09-26
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Provider Licenses
StateLicense IDTaxonomies
AZ10690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ166566Medicaid