Individual
MARK NUNZIO MASOTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A61275
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A612750
BLUE SHIELD OF CA
—
05
—
00A612750
—
CA
01
—
00A612750 159
CALOPTIMA
—
01
—
053304CH71589
TRAILBLAZER
—
01
—
300136609
RAILROAD MEDICARE
—
Enumeration date
07/19/2005
Last updated
08/15/2008
Update your record
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