Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | ME102291 | FL |
Y | 208200000X | Surgeon | 57228 | AZ |
Y | 208600000X | Surgeon | 57228 | AZ |
NPI | 1164678421 |
---|---|
Provider Name | Alessandro Gaetano Cusano |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/12/2018 |