Healthcare Provider Details

I. General information

NPI: 1508527797
Provider Name (Legal Business Name): MODENA ALLERGY & ASTHMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 710
LA JOLLA CA
92037-1218
US

IV. Provider business mailing address

9850 GENESEE AVE STE 710
LA JOLLA CA
92037-1218
US

V. Phone/Fax

Practice location:
  • Phone: 858-283-3963
  • Fax: 858-332-1811
Mailing address:
  • Phone: 858-283-3963
  • Fax: 858-332-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN D MODENA
Title or Position: DIRECTOR & SECRETARY
Credential: MD, MSC
Phone: 412-689-0636