Provider Demographics
NPI:1063845782
Name:ALEXANDER S TOVAR MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALEXANDER S TOVAR MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-8311
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:#425
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-848-8311
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:#425
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-848-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty