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?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty