Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 002448 | NY |
N | 208200000X | Surgeon | 002448 | NY |
N | 208600000X | Surgeon | 002448 | NY |
N | 208200000X | Surgeon | 30592 | AZ |
N | 208600000X | Surgeon | 30592 | AZ |
NPI | 1306996053 |
---|---|
Provider Name | Dr. Manuel Ignacio Rodriguez-Davalos |
First Address | New Haven, CT 06520-8062 |
Second Address | New Haven, CT 06510-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 28/04/2011 |