Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 17060 | AZ |
NPI | 1003864380 |
---|---|
Provider Name | Manuel Modiano |
First Address | Tucson, AZ 85712-6687 |
Second Address | Tucson, AZ 85712-6686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E58282 | (02) | AZ |