Provider Demographics
NPI:1558587931
Name:ASTARITA, DENIS C (MD)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:C
Last Name:ASTARITA
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 1:1500 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2500
Mailing Address - Country:US
Mailing Address - Phone:775-289-3001
Mailing Address - Fax:775-289-6423
Practice Address - Street 1:1500 AVE H.
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2500
Practice Address - Country:US
Practice Address - Phone:775-289-3001
Practice Address - Fax:775-289-6423
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31184208600000X
NV10430208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G311841Medicaid
FM592ZMedicare PIN
CA00G34484Medicare ID - Type Unspecified
CAA44781Medicare UPIN