Provider Demographics
NPI:1518037019
Name:POLITO, GREGORY EUGENE
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:POLITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 PAINTER AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3102
Mailing Address - Country:US
Mailing Address - Phone:562-907-7600
Mailing Address - Fax:562-907-7602
Practice Address - Street 1:8135 PAINTER AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3102
Practice Address - Country:US
Practice Address - Phone:562-907-7600
Practice Address - Fax:562-907-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23699208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340002887OtherRAILROAD MEDICARE
CAEA844ZOtherMEDICARE PTAN
CA00G23699Medicaid
CA340002887OtherRAILROAD MEDICARE