Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD00011772 | WA |
NPI | 1013179993 |
---|---|
Provider Name | Dr. Carlo Claudio Manetti |
First Address | Lakewood, WA 98496-0097 |
Second Address | Lakewood, WA 98499-1745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A16800 | (02) |