Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 33661 | AZ |
NPI | 1003849514 |
---|---|
Provider Name | Dr. Lino Ossanna |
First Address | Chandler, AZ 85248-2758 |
Second Address | Queen Creek, AZ 85242-5996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
922428 | (05) | AZ |
H28015 | (02) | AZ |