Provider Demographics
NPI:1093714743
Name:WAISSBLUTH, ALVARO DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:DANIEL
Last Name:WAISSBLUTH
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 1:30287 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-6666
Mailing Address - Country:US
Mailing Address - Phone:650-922-6446
Mailing Address - Fax:
Practice Address - Street 1:2070 CLINTON AVE FL 3
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4399
Practice Address - Country:US
Practice Address - Phone:510-522-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154770207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149802OtherMOLINA HEALTHCARE
KY64009624Medicaid
OH000000524485OtherANTHEM
OH208679830029OtherCARESOURCE
OH283931OtherAMERIGROUP
IN200248900Medicaid
OH2149802Medicaid
OH000000524485OtherANTHEM
KY64009624Medicaid