Healthcare Provider Details

I. General information

NPI: 1518836444
Provider Name (Legal Business Name): MODENA ALLERGY & ASTHMA II INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE 140
VISTA CA
92083-6032
US

IV. Provider business mailing address

2067 W VISTA WAY STE 140
VISTA CA
92083-6032
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-4444
  • Fax: 858-332-1811
Mailing address:
  • Phone: 760-941-4444
  • Fax: 760-941-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DAVID MODENA
Title or Position: CEO & DIRECTOR
Credential: MD, MSC
Phone: 858-260-2977