Provider Demographics
NPI:1801906771
Name:MASTRIN, MARCIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:MASTRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2473
Mailing Address - Country:US
Mailing Address - Phone:602-236-8800
Mailing Address - Fax:602-368-8801
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2473
Practice Address - Country:US
Practice Address - Phone:602-368-8800
Practice Address - Fax:602-368-8801
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0770960OtherBCBS
AZ927270Medicaid
AZ927270Medicaid
AZAZ0770960OtherBCBS