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General NPI Number Information
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NPI Number | 1710227673
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Entity Type | Organization
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Legal Business Name | PATRICK D AIELLO MD LLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 11551 S FORTUNA RD STE E
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City | YUMA
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State | AZ
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Zip | 85367-7853
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Country | US
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Telephone | 928-503-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 275 W 28TH ST
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City | YUMA
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State | AZ
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Zip | 85364-7308
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Country | US
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Telephone | 928-782-1980
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. MARLENE DENISE AIELLO
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Credential | R.N.
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Telephone | 928-503-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 21328
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License Number State | AZ
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