Individual
DUSTIN MICHAEL IACOBAZZI RIECAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
8514 49TH ST W, UNIVERSITY PLACE, WA 98467
(253) 380-0434
Mailing address
8514 49TH ST W, UNIVERSITY PLACE, WA 98467
(253) 380-0434
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60158705
WA
Other
Enumeration date
07/15/2010
Last updated
12/22/2011
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