Basic Information
Provider Information
NPI: 1013039189
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATO
FirstName: MICHELE
MiddleName: TORTORA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1520 SAN PABLO ST
Address2: STE1652
City: LOS ANGELES
State: CA
PostalCode: 900335321
CountryCode: US
TelephoneNumber: 3234426000
FaxNumber: 3234426001
Practice Location
Address1: 1520 SAN PABLO ST
Address2: STE1652
City: LOS ANGELES
State: CA
PostalCode: 900335321
CountryCode: US
TelephoneNumber: 3234426000
FaxNumber: 3234426001
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 04/13/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XG87717CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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