Provider Demographics
NPI:1871052126
Name:MAFFUCCI, CARMEN ALEXANDRA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ALEXANDRA
Last Name:MAFFUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HEALTHCARE OPERATIONS SQUADRON
Mailing Address - Street 2:UNIT 14010
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543
Mailing Address - Country:US
Mailing Address - Phone:671-366-2688
Mailing Address - Fax:
Practice Address - Street 1:36 HEALTHCARE OPERATIONS SQUADRON
Practice Address - Street 2:UNIT 14010
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96543
Practice Address - Country:US
Practice Address - Phone:671-366-2688
Practice Address - Fax:671-366-6467
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant