Provider Demographics
NPI:1679580344
Name:ALLEGRA, DAVID P (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:ALLEGRA
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 1:2336 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2095
Mailing Address - Country:US
Mailing Address - Phone:310-828-7226
Mailing Address - Fax:310-828-4426
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-828-7226
Practice Address - Fax:310-828-4426
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG715992085R0204X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15185AOtherMEDICARE PTAN - FACILITY
CAG71599OtherMEDICAL LICENSE
CAG71599OtherMEDICAL LICENSE
CAW15185AOtherMEDICARE PTAN - FACILITY