Provider Demographics
NPI:1215149745
Name:A GREGORY CARUSO MD INC
Entity type:Organization
Organization Name:A GREGORY CARUSO MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-568-4939
Mailing Address - Street 1:73211 FRED WARING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2871
Mailing Address - Country:US
Mailing Address - Phone:760-568-4939
Mailing Address - Fax:760-341-8544
Practice Address - Street 1:73-211 FRED WARING DRIVE, STE. 100
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-568-4939
Practice Address - Fax:760-341-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16322ZMedicare ID - Type Unspecified