Individual
RAQUEL MASCORRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, SUITE 774, PORT ORANGE, FL 32128
(800) 330-7711
Mailing address
525 E CREIGHTON AVE, FORT WAYNE, IN 46803-2471
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32001513A
IN
Other
Enumeration date
01/31/2008
Last updated
02/06/2013
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