MEDICARE: DR. MARIO N ALBERTI DDS

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	1223G0001X	General Practice Dentistry	035832	CA

General Provider Information

NPI Number	:	1982705893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO N ALBERTI DDS

Provider Business Mailing Address
First Line	:	4520 EXECUTIVE DRIVE
Second Line	:	SUITE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92121
Country	:	US
Telephone Number	:	858-623-9024
Fax Number	:	858-623-9399

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	SUITE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-623-9024
Fax Number	:	858-623-9399

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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