Provider Demographics
NPI:1972807683
Name:PESCE, AMADEO (PHD)
Entity type:Individual
Prefix:
First Name:AMADEO
Middle Name:
Last Name:PESCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 MIRA MESA BLVD
Mailing Address - Street 2:STE 123-BOX 153
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4311
Mailing Address - Country:US
Mailing Address - Phone:800-635-6901
Mailing Address - Fax:858-228-9909
Practice Address - Street 1:4215 SORRENTO VALLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1408
Practice Address - Country:US
Practice Address - Phone:800-635-6901
Practice Address - Fax:858-228-9909
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRI-100000098207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology