Provider Demographics
NPI:1205969250
Name:DAGNOLO, ALESSANDRO (MD)
Entity type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:
Last Name:DAGNOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4313
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4313
Mailing Address - Country:US
Mailing Address - Phone:805-375-8800
Mailing Address - Fax:805-375-8900
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM M 335
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA642322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A642320Medicaid
BD6398057OtherUS DEPT OF JUSTICE DEA
WA64232AMedicare ID - Type Unspecified
BD6398057OtherUS DEPT OF JUSTICE DEA