Healthcare Provider Details

I. General information

NPI: 1588609382
Provider Name (Legal Business Name): ANGELA ALLEVATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. ANGELA ALLEVATO BUTLER

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S BATAVIA ST #203
ORANGE CA
92868-3936
US

IV. Provider business mailing address

431 S BATAVIA ST #203
ORANGE CA
92868-3936
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-0662
  • Fax: 714-639-0660
Mailing address:
  • Phone: 714-639-0662
  • Fax: 714-639-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG072682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: