Provider Demographics
NPI:1912295163
Name:FOSSATI-BELLANI, MARCO RICCARDO (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:RICCARDO
Last Name:FOSSATI-BELLANI
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:924 WESTWOOD BOULEVARD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1777
Mailing Address - Country:US
Mailing Address - Phone:310-794-0585
Mailing Address - Fax:
Practice Address - Street 1:924 WESTWOOD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1777
Practice Address - Country:US
Practice Address - Phone:310-794-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA125564207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine