Provider Demographics
NPI:1124200381
Name:MIGUEL, ALFONSO P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:P
Last Name:MIGUEL
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 1:102 W ROUTE 66 STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6247
Mailing Address - Country:US
Mailing Address - Phone:626-914-3835
Mailing Address - Fax:626-963-4613
Practice Address - Street 1:102 W ROUTE 66 STE A
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6247
Practice Address - Country:US
Practice Address - Phone:626-914-3835
Practice Address - Fax:626-963-4613
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA230442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A230440Medicaid
CAA23044Medicare PIN
CA00A230440Medicaid