Provider Demographics
NPI:1336411503
Name:POLITO, SANTO SALVATORE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTO
Middle Name:SALVATORE
Last Name:POLITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 BEAUDRY TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1700
Mailing Address - Country:US
Mailing Address - Phone:818-248-0588
Mailing Address - Fax:
Practice Address - Street 1:3255 BEAUDRY TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1700
Practice Address - Country:US
Practice Address - Phone:818-248-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE9918207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease