Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 26813 | AZ |
NPI | 1104999887 |
---|---|
Provider Name | Wayne Chiavacci |
First Address | Yuma, AZ 85364-5517 |
Second Address | Yuma, AZ 85364-5517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432344 | (05) | AZ |