Provider Demographics
NPI:1346839412
Name:MARIO AMMIRATI M D INC
Entity Type:Organization
Organization Name:MARIO AMMIRATI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMIRATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-266-6171
Mailing Address - Street 1:610 KALAMATH DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2628
Mailing Address - Country:US
Mailing Address - Phone:267-266-6171
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 608
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3199
Practice Address - Country:US
Practice Address - Phone:619-800-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty