Basic Information
| Provider Information | |||||||||
| NPI: | 1295842300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANCIOSA | ||||||||
| FirstName: | STEFAN | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9990 DOUBLE R BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895216014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753488800 | ||||||||
| FaxNumber: | 7753488818 | ||||||||
| Practice Location | |||||||||
| Address1: | 9990 DOUBLE R BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895216014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753488800 | ||||||||
| FaxNumber: | 7753488818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | OS012048 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MB08532400 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | DO2019 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | DO2019 | 01 | NV | NV LICENSE | OTHER | FF1305285 | 01 | NJ | NJ DEA | OTHER | MB08532400 | 01 | NJ | NJ LICENSE | OTHER | BF8312693 | 01 | DEA | OTHER | OS012048 | 01 | PA | PA LICENSE NUMBER | OTHER |