David Iannicca
Sports Medicine
15946 N Bullard Ave
Surprise
, Arizona 85374-8844
David Iannicca
Sports Medicine
15946 N Bullard Ave
Surprise
, Arizona 85374-8844
(440) 223-0569
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About
Features
Specialties
- Sports Medicine
Languages spoken
- English
Location
First Address
- David Iannicca
- 920 Center Rd
- Eastlake, OH
- Zip : 44095-2332
- Phone : (440) 223-0569
Second Address
- David Iannicca
- 15946 N Bullard Ave
- Surprise, AZ
- Zip : 85374-8844
- Phone : (816) 277-2954
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2081S0010X | Sports Medicine | 0126000756 | VA |
| Y | 213ES0000X | Sports Medicine | 0126000756 | VA |
National Provider Identifier
| NPI | 1245455666 |
|---|---|
| Provider Name | David Iannicca |
| First Address | Eastlake, OH 44095-2332 |
| Second Address | Surprise, AZ 85374-8844 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/04/2007 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.