Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DA027591-A | PA |
NPI | 1295190064 |
---|---|
Provider Name | Francisco J Pico Fazzi |
First Address | Plymouth Meeting, PA 19462-1245 |
Second Address | Plymouth Meeting, PA 19462-1036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2015 |
Last Update Date | 22/12/2015 |