Provider Demographics
NPI:1225011034
Name:AMADEO, ALESSANDRA M (MD)
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:M
Last Name:AMADEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10050
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-7550
Mailing Address - Country:US
Mailing Address - Phone:310-335-4065
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:3531 FASHION WAY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4807
Practice Address - Country:US
Practice Address - Phone:310-792-6539
Practice Address - Fax:310-977-2365
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52834174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA52834KOtherSAN PEDRO MEDICARE
CAWA52834FOtherST JUDE MEDICARE
CAWA52834GOtherST JOHNS MEDICARE
CA00A528340Medicaid
CAWA52834KOtherSAN PEDRO MEDICARE
CAWA52834IMedicare ID - Type Unspecified