Provider Demographics
NPI:1952489965
Name:POLITO, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:POLITO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 BANCROFT AVE
Mailing Address - Street 2:SUITE G 4
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5147
Mailing Address - Country:US
Mailing Address - Phone:510-483-1234
Mailing Address - Fax:510-483-1099
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:SUITE G 4
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-1234
Practice Address - Fax:510-483-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG38953207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G389530Medicaid
CAA47647Medicare UPIN