Provider Demographics
NPI:1053553297
Name:MASTRONARDI, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MASTRONARDI
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 1:2200 S AVENUE B
Mailing Address - Street 2:APT. A105
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6173
Mailing Address - Country:US
Mailing Address - Phone:520-661-4281
Mailing Address - Fax:
Practice Address - Street 1:2200 S AVENUE B
Practice Address - Street 2:APT. A105
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6173
Practice Address - Country:US
Practice Address - Phone:520-661-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist