Provider Demographics
NPI:1134574783
Name:ANSALDO, WARREN G (OD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:G
Last Name:ANSALDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10957 KNOXVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5289
Mailing Address - Country:US
Mailing Address - Phone:949-689-4332
Mailing Address - Fax:
Practice Address - Street 1:7038 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2805
Practice Address - Country:US
Practice Address - Phone:714-895-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33418TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist