Provider Demographics
NPI:1962046110
Name:DOVIDIO, JOSEPH JOHN III (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:DOVIDIO
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-3851
Mailing Address - Fax:310-423-0246
Practice Address - Street 1:127 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:310-423-3851
Practice Address - Fax:310-423-0246
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP020980363LA2100X, 363LC0200X
NJ26NJ01234000363LC0200X
CA95023352363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine