Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 72-193 | NM |
NPI | 1417982349 |
---|---|
Provider Name | Alice Marosi |
First Address | Albuquerque, NM 87108-4729 |
Second Address | Albuquerque, NM 87108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14159 | (05) | NM |
E47904 | (02) |