Provider Demographics
NPI:1528498037
Name:MAMOLA, FRANK (RDMS)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:MAMOLA
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19260 N 78TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6129
Mailing Address - Country:US
Mailing Address - Phone:602-717-0772
Mailing Address - Fax:602-419-2988
Practice Address - Street 1:209 E ROSE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1242
Practice Address - Country:US
Practice Address - Phone:602-265-3199
Practice Address - Fax:602-419-2988
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4052732471C3402X
AZ1292422471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography