Healthcare Provider Details

I. General information

NPI: 1497790018
Provider Name (Legal Business Name): ANTHONY J CULOTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE SUITE 312
PASADENA CA
91105-3150
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD SUITE 312
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 626-568-8838
  • Fax: 626-583-8838
Mailing address:
  • Phone: 626-568-8838
  • Fax: 626-583-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number025662
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number061228
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA97142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: