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General NPI Number Information
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NPI Number | 1518836444
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Entity Type | Organization
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Legal Business Name | MODENA ALLERGY & ASTHMA II INC.
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 2067 W VISTA WAY STE 140
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City | VISTA
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State | CA
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Zip | 92083-6032
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Country | US
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Telephone | 760-941-4444
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Fax | 858-332-1811
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Provider Business Mailing Address
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Address Line | 2067 W VISTA WAY STE 140
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City | VISTA
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State | CA
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Zip | 92083-6032
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Country | US
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Telephone | 760-941-4444
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Fax | 760-941-8902
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Authorized Official
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Title or Position | CEO & DIRECTOR
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Name | BRIAN DAVID MODENA
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Credential | MD, MSC
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Telephone | 858-260-2977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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