MEDICARE: DR. ALESSANDRO GAETANO CUSANO MD,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	C130958	CA
2	208200000X	Plastic Surgery Physician	57228	AZ
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	ME102291	FL
4	208200000X	Plastic Surgery Physician	155349	FL

General Provider Information

NPI Number	:	1164678421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALESSANDRO GAETANO CUSANO MD,

Provider Business Mailing Address
First Line	:	145 FOSS CREEK CIR
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-4288
Country	:	US
Telephone Number	:	707-473-0220
Fax Number	:	707-473-0990

Provider Business Practice Location Address
First Line	:	145 FOSS CREEK CIR
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-4288
Country	:	US
Telephone Number	:	707-473-0220
Fax Number	:	707-473-0990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	01/28/2026

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