MEDICARE: DR. EVA ALTOBELLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	248241	NY
2	2084P0802X	Addiction Psychiatry Physician	A 102265	CA

General Provider Information

NPI Number	:	1790990620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVA ALTOBELLI MD

Provider Business Mailing Address
First Line	:	1810 14TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4660
Country	:	US
Telephone Number	:	610-348-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 14TH ST STE 206
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-4662
Country	:	US
Telephone Number	:	516-569-6600
Fax Number	:	516-374-2261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/03/2021

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