Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 7680 | NE |
NPI | 1003266438 |
---|---|
Provider Name | Dr. Alida Fiamengo |
First Address | Truckee, CA 96161-4861 |
Second Address | Truckee, CA 96161-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 25/08/2021 |