Provider Demographics
NPI: | 1437421427 |
---|---|
Name: | D'AMBROSIO MEDICAL GROUP, INC |
Entity Type: | Organization |
Organization Name: | D'AMBROSIO MEDICAL GROUP, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | FRANCIS |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | D'AMBROSIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-346-6020 |
Mailing Address - Street 1: | 22631 PACIFIC COAST HWY # 793 |
Mailing Address - Street 2: | |
Mailing Address - City: | MALIBU |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90265-5036 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 22631 PACIFIC COAST HWY # 793 |
Practice Address - Street 2: | |
Practice Address - City: | MALIBU |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90265-5036 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-346-6020 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-06 |
Last Update Date: | 2014-01-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207LC0200X | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 209800000X | Allopathic & Osteopathic Physicians | Legal Medicine | Group - Multi-Specialty |