Provider Demographics
NPI:1649496092
Name:ADDARIO, DOMINICK (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:ADDARIO
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 1:3010 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5816
Mailing Address - Country:US
Mailing Address - Phone:619-295-2189
Mailing Address - Fax:619-295-2362
Practice Address - Street 1:3010 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5816
Practice Address - Country:US
Practice Address - Phone:619-295-2189
Practice Address - Fax:619-295-2362
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG216202084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL156ZMedicare UPIN