Provider Demographics
NPI: | 1508527797 |
---|---|
Name: | MODENA ALLERGY & ASTHMA INC. |
Entity Type: | Organization |
Organization Name: | MODENA ALLERGY & ASTHMA INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR & SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | MODENA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, MSC |
Authorized Official - Phone: | 412-689-0636 |
Mailing Address - Street 1: | 9850 GENESEE AVE STE 710 |
Mailing Address - Street 2: | |
Mailing Address - City: | LA JOLLA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92037-1218 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 858-283-3963 |
Mailing Address - Fax: | 858-332-1811 |
Practice Address - Street 1: | 9850 GENESEE AVE STE 710 |
Practice Address - Street 2: | |
Practice Address - City: | LA JOLLA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92037-1218 |
Practice Address - Country: | US |
Practice Address - Phone: | 858-283-3963 |
Practice Address - Fax: | 858-332-1811 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-01-10 |
Last Update Date: | 2022-01-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RA0201X | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | Group - Single Specialty |