Healthcare Provider Details

I. General information

NPI: 1013273036
Provider Name (Legal Business Name): MICHAEL ANTHONY AVALLONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S PALISADE DR STE 110
SANTA MARIA CA
93454-8905
US

IV. Provider business mailing address

225 PRADO RD STE D
SAN LUIS OBISPO CA
93401-7363
US

V. Phone/Fax

Practice location:
  • Phone: 805-349-7133
  • Fax: 805-349-7137
Mailing address:
  • Phone: 805-786-2500
  • Fax: 805-781-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA155941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: