Provider Demographics
NPI:1457398844
Name:DEPAOLIL, ALEX M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:DEPAOLIL
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 1:645 STODDARD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1054
Mailing Address - Country:US
Mailing Address - Phone:805-447-3423
Mailing Address - Fax:
Practice Address - Street 1:2219 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4321
Practice Address - Country:US
Practice Address - Phone:805-447-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF80012Medicare UPIN