Provider Demographics
NPI:1477518421
Name:DE VITO, ALESSANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:
Last Name:DE VITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20001 S RANCHO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6318
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7040
Practice Address - Street 1:20001 S RANCHO WAY
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-6318
Practice Address - Country:US
Practice Address - Phone:310-225-3244
Practice Address - Fax:310-698-7040
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50687207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4842079-1205OtherPHYSICIAN LICENSE
CA00A506870Medicaid
IN01067227AOtherPHYSICIAN LICENSE
CO39304OtherPHYSICIAN LICENSE
OH35.094397OtherPHYSICIAN LICENSE
AZ36995OtherPHYSICIAN LICENSE
NV10631OtherPHYSICIAN LICENSE
MI4301095525OtherPHYSICIAN LICENSE
WY8225AOtherPHYSICIAN LICENSE
PAHI139164OtherPHYSICIAN LICENSE
ORMD153286OtherPHYSICIAN LICENSE
AZ36995OtherPHYSICIAN LICENSE
CAWA50687LMedicare PIN
IN01067227AOtherPHYSICIAN LICENSE
OH35.094397OtherPHYSICIAN LICENSE
NV10631OtherPHYSICIAN LICENSE
CAWA50687KMedicare PIN