Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 24575 | AZ |
N | 207QS0010X | Family Doctor - Sports Medicine | 24575 | AZ |
NPI | 1154410157 |
---|---|
Provider Name | Alex Joseph Onofrei |
First Address | Mesa, AZ 85205-4960 |
Second Address | Mesa, AZ 85205-4960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 30/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G43630 | (02) | AZ |
Z106146 | MEDICARE ID-PIN (01) | AZ |