Healthcare Provider Details

I. General information

NPI: 1831495571
Provider Name (Legal Business Name): ATALANTA C OLITO OSTEOPATHIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 MAGNOLIA AVE 200
RIVERSIDE CA
92503-4436
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-7270
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A6471
License Number StateCA

VIII. Authorized Official

Name: ATALANTA C OLITO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 310-792-3914