Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | A87681 | CA |
NPI | 1114903648 |
---|---|
Provider Name | Dr. Ricardo Avena |
First Address | Fresno, CA 93720-0340 |
Second Address | Fresno, CA 93720-0340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 27/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I18040 | (02) |