Healthcare Provider Details

I. General information

NPI: 1316216005
Provider Name (Legal Business Name): GIULIANO MARIO SELNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2011
Last Update Date: 12/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 N 45TH LN
GLENDALE AZ
85301-6208
US

IV. Provider business mailing address

5802 N 45TH LN
GLENDALE AZ
85301-6208
US

V. Phone/Fax

Practice location:
  • Phone: 602-575-4351
  • Fax:
Mailing address:
  • Phone: 602-575-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCERTIFICATION
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: