Basic Information
| Provider Information | |||||||||
| NPI: | 1225011034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMADEO | ||||||||
| FirstName: | ALESSANDRA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10050 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902677550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103354065 | ||||||||
| FaxNumber: | 3103354098 | ||||||||
| Practice Location | |||||||||
| Address1: | 3531 FASHION WAY | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905034807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107926539 | ||||||||
| FaxNumber: | 3109772365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A52834 | CA | N | Other Service Providers | Specialist | 2085R0001X | A52834 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | WA52834K | 01 | CA | SAN PEDRO MEDICARE | OTHER | WA52834F | 01 | CA | ST JUDE MEDICARE | OTHER | WA52834G | 01 | CA | ST JOHNS MEDICARE | OTHER | 00A528340 | 05 | CA | MEDICAID |