Provider Demographics
NPI:1770692774
Name:GALASSO, MAURIZIO (MD)
Entity type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:
Last Name:GALASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W. THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE W202
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-678-1111
Mailing Address - Fax:602-678-7090
Practice Address - Street 1:5757 W. THUNDERBIRD ROAD
Practice Address - Street 2:SUITE W202
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-678-1111
Practice Address - Fax:602-678-7090
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26113207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ432609OtherAHCCS
AZ432609OtherAHCCS
AZG70788Medicare UPIN