De Fiesta, Mark Nacianceno
De Fiesta, Mark Nacianceno is an individual health care provider with primary practice located at 326 Country Club Dr , New Albany IN 47150. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. De Fiesta, Mark Nacianceno can be contacted via phone (812) 948-1311.Contact Information
Primary practice address
326 Country Club Dr
New Albany IN 47150
Phone: (812) 948-1311
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X |
Profile Details
| NPI number | 1932699147 |
|---|---|
| LBN Legal business name | De Fiesta, Mark Nacianceno |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 14th, 2018 |
| Last updated | May 14th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932699147 | NPPES |
| Georgia | Other | OJH016M89073 | BLUECROSSBLUESHIELD |
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