Provider Demographics
NPI:1104814086
Name:GEDISSMAN, ALBERTO (MD)
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:
Last Name:GEDISSMAN
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 1:3141 MICHELSON DR
Mailing Address - Street 2:APT 1404
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-5623
Mailing Address - Country:US
Mailing Address - Phone:714-425-4319
Mailing Address - Fax:949-854-3975
Practice Address - Street 1:1515 S BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-2253
Practice Address - Country:US
Practice Address - Phone:714-919-0280
Practice Address - Fax:714-288-8970
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA26326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A263260Medicaid