Provider Demographics
NPI:1477588663
Name:EVANGELATOS, DENNIS W (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:EVANGELATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 S SPALDING DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1800
Mailing Address - Country:US
Mailing Address - Phone:424-239-2400
Mailing Address - Fax:424-239-2403
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:SUITE 403
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:424-239-2400
Practice Address - Fax:424-239-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB229152Medicare PIN
CAY02127Medicare UPIN