Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A82438 | CA |
NPI | 1003836594 |
---|---|
Provider Name | Antonio Domenico Muto-Isolani |
First Address | Emeryville, CA 94608-1826 |
Second Address | Alameda, CA 94501-4320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82287 | (02) | CA |