Provider Demographics
NPI:1346565082
Name:DOMINICK ADDARIO MD APC
Entity Type:Organization
Organization Name:DOMINICK ADDARIO MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINCK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-2189
Mailing Address - Street 1:3010 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5816
Mailing Address - Country:US
Mailing Address - Phone:619-295-2189
Mailing Address - Fax:619-295-2362
Practice Address - Street 1:3010 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5816
Practice Address - Country:US
Practice Address - Phone:619-295-2189
Practice Address - Fax:619-295-2362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINICK ADDARIO MD APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG216202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL154AMedicare UPIN