Provider Demographics
NPI:1508825662
Name:CARUSO, ALFRED GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:GREGORY
Last Name:CARUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73-211 FRED WARING DR
Mailing Address - Street 2:STE 100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-568-4939
Mailing Address - Fax:760-568-4769
Practice Address - Street 1:73-211 FRED WARING DR
Practice Address - Street 2:STE 100
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-568-4939
Practice Address - Fax:760-568-4769
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42058Medicare UPIN