Basic Information
| Provider Information | |||||||||
| NPI: | 1558587931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASTARITA | ||||||||
| FirstName: | DENIS | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893001 | ||||||||
| FaxNumber: | 7752896423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 AVE H. | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893001 | ||||||||
| FaxNumber: | 7752896423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 11/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G31184 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 10430 | NV | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G311841 | 05 | CA | MEDICAID |