Provider Demographics
NPI:1821062316
Name:ODIO, ALBERTO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:JOSE
Last Name:ODIO
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 1:2925 SYCAMORE DR
Mailing Address - Street 2:SUITE 204/205
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1207
Mailing Address - Country:US
Mailing Address - Phone:805-578-9620
Mailing Address - Fax:805-583-0414
Practice Address - Street 1:2925 SYCAMORE DR
Practice Address - Street 2:SUITE 204/205
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1207
Practice Address - Country:US
Practice Address - Phone:805-578-9620
Practice Address - Fax:805-955-0498
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG41862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G418620Medicaid
CA00G418620Medicaid