Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A70764 | CA |
N | 208600000X | Surgeon | A70764 | CA |
N | 208200000X | Surgeon | MD00043132 | WA |
N | 208600000X | Surgeon | MD00043132 | WA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A70764 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD00043132 | WA |
NPI | 1063436731 |
---|---|
Provider Name | Dr. Costanzo Aldo Diperna |
First Address | Carmichael, CA 95608-0302 |
Second Address | Carmichael, CA 95608-0302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 29/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8470841 | (05) | WA |
I60123 | (02) | WA |