Provider Demographics
NPI:1710926472
Name:MUZZARELLI, UBERTO T (MD)
Entity Type:Individual
Prefix:
First Name:UBERTO
Middle Name:T
Last Name:MUZZARELLI
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 1:605 WEST H STREET
Mailing Address - Street 2:ADVANCED MEDICAL BILLING SUITE 110
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227
Mailing Address - Country:US
Mailing Address - Phone:760-344-7976
Mailing Address - Fax:760-344-7106
Practice Address - Street 1:450 EAST BIRCH STREET
Practice Address - Street 2:CALEXICO HELATH CENTER
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231
Practice Address - Country:US
Practice Address - Phone:760-768-6262
Practice Address - Fax:760-768-6292
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G162660Medicaid
CAG16266AMedicare ID - Type Unspecified
CAA39755Medicare UPIN