Provider Demographics
NPI:1316334204
Name:DICONTI-GIBBS, ANALIESE MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANALIESE
Middle Name:MARIE
Last Name:DICONTI-GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANALIESE
Other - Middle Name:
Other - Last Name:DICONTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 MARENGO ST
Mailing Address - Street 2:CLINIC TOWER A6E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1352
Mailing Address - Country:US
Mailing Address - Phone:323-409-5669
Mailing Address - Fax:
Practice Address - Street 1:2051 MARENGO STREET
Practice Address - Street 2:CLINIC TOWER A6E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1352
Practice Address - Country:US
Practice Address - Phone:323-409-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144827208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAD3232267556Medicaid