Provider Demographics
NPI:1043849318
Name:VALLEJO, ALVIN (RN PHN)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:M
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132
Mailing Address - Country:US
Mailing Address - Phone:415-690-6288
Mailing Address - Fax:
Practice Address - Street 1:30 VAN NESS
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-581-2411
Practice Address - Fax:415-581-2490
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA851593163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse