Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 18708 | NV |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 18708 | NV |
NPI | 1508208943 |
---|---|
Provider Name | Spenser Cassinelli |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13626723 | CAQH (01) | |
250002550 | (05) | NV |