Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 43293 | AZ |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 43293 | AZ |
NPI | 1063603843 |
---|---|
Provider Name | Amalia M De Comas |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Mesa, AZ 85202-4712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 23/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
522933 | (05) | AZ |