Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | FE60499500 | WA |
NPI | 1043615958 |
---|---|
Provider Name | Moreno Festuccia |
First Address | Seattle, WA 98109-5146 |
Second Address | Seattle, WA 98109-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |