Healthcare Provider Details

I. General information

NPI: 1184334112
Provider Name (Legal Business Name): EVA ALTOBELLI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 6TH ST
SANTA MONICA CA
90401-1650
US

IV. Provider business mailing address

1218 6TH ST
SANTA MONICA CA
90401-1650
US

V. Phone/Fax

Practice location:
  • Phone: 424-877-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EVA ALTOBELLI
Title or Position: OWNER
Credential: MD
Phone: 424-877-1333