Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 304 | CO |
Y | 222Z00000X | Podiatrist | 304 | CO |
NPI | 1033188917 |
---|---|
Provider Name | Dr. Angelo Sam Giarratano |
First Address | Pueblo, CO 81001-1256 |
Second Address | Pueblo, CO 81001-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 04/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480033178 | RAILROAD MEDICARE (01) | |
51963 | BCBS (01) | |
T60320 | (02) |