Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A28404 | CA |
NPI | 1043378086 |
---|---|
Provider Name | Dr. Angelo Scavarda |
First Address | Petaluma, CA 94954-8569 |
Second Address | Petaluma, CA 94954-8569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |