Healthcare Provider Details

I. General information

NPI: 1003864380
Provider Name (Legal Business Name): MANUEL MODIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 E PARADISE FALLS DR STE 105
TUCSON AZ
85712-6686
US

IV. Provider business mailing address

3945 E PARADISE FALLS DR STE 201
TUCSON AZ
85712-6687
US

V. Phone/Fax

Practice location:
  • Phone: 520-689-7030
  • Fax: 520-395-9796
Mailing address:
  • Phone: 520-689-7030
  • Fax: 520-395-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: