Individual
MANUEL MASCARENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P. A.
Contact information
Practice address
5190 E FARNESS DR STE 104, TUCSON, AZ 85712-2142
(520) 795-7724
Mailing address
5190 E FARNESS DR STE 104, TUCSON, AZ 85712-2142
(520) 795-7724
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1375
PR
363A00000X
Physician Assistant
Primary
9876
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9876
—
AZ
Enumeration date
08/15/2023
Last updated
08/18/2023
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