Provider Demographics
NPI:1649495029
Name:CACCIARELLI, ALEXANDER ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ANTHONY
Last Name:CACCIARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2198 LADYCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1978
Mailing Address - Country:US
Mailing Address - Phone:805-492-0275
Mailing Address - Fax:805-492-0275
Practice Address - Street 1:2198 LADYCLIFF CIR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1978
Practice Address - Country:US
Practice Address - Phone:805-492-0275
Practice Address - Fax:805-492-0275
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI356502085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology