Provider Demographics
NPI:1881241321
Name:ATTO, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ATTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S MOLLISON AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6518
Mailing Address - Country:US
Mailing Address - Phone:619-253-1946
Mailing Address - Fax:
Practice Address - Street 1:807 S MOLLISON AVE UNIT 12
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6518
Practice Address - Country:US
Practice Address - Phone:619-253-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4200259172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver