Provider Demographics
NPI:1114954955
Name:ALVARADO, ANTHONY SEBASTIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:SEBASTIAN
Last Name:ALVARADO
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 1:125 N JACKSON AVE
Mailing Address - Street 2:#101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-258-6565
Mailing Address - Fax:408-258-1220
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:#101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-258-6565
Practice Address - Fax:408-258-1220
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37874207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06929ZOtherBLUE SHIELD
CAZZZ28805ZOtherBLUE SHIELD
CAZZZ28805ZOtherBLUE SHIELD
A36779Medicare UPIN