Provider Demographics
NPI:1912983008
Name:MASCOVICH, DEBBIE SUNSHINE (PAC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SUNSHINE
Last Name:MASCOVICH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47328
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7328
Mailing Address - Country:US
Mailing Address - Phone:970-778-1432
Mailing Address - Fax:
Practice Address - Street 1:5201 N 19TH AVE STE 121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2901
Practice Address - Country:US
Practice Address - Phone:602-433-1822
Practice Address - Fax:602-246-7060
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO763363A00000X
AZ5137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03457036Medicaid
S12724Medicare UPIN
CO03457036Medicaid