Provider Demographics
NPI:1184718454
Name:ALBERICO, MICHAEL ARTIE (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARTIE
Last Name:ALBERICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5462
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91734-1462
Mailing Address - Country:US
Mailing Address - Phone:626-442-7455
Mailing Address - Fax:626-442-4548
Practice Address - Street 1:4346 N COGSWELL RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2016
Practice Address - Country:US
Practice Address - Phone:626-442-7455
Practice Address - Fax:626-442-4548
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3637213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36372Medicaid
CA480009046OtherRAILROAD MEDICARE
CAE3637Medicare PIN
T95603Medicare UPIN