Provider Demographics
NPI:1760467286
Name:MUSTO, LORI (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MUSTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:881 ALMA REAL DR
Mailing Address - Street 2:STE 110
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3731
Mailing Address - Country:US
Mailing Address - Phone:310-454-1212
Mailing Address - Fax:310-454-2185
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:STE 110
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:310-454-1212
Practice Address - Fax:310-454-2185
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2010-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE75903Medicare UPIN
CA20A6735Medicare ID - Type Unspecified