Provider Demographics
NPI:1134292006
Name:ALVAREZ, TARQUINA DIANA
Entity Type:Individual
Prefix:
First Name:TARQUINA
Middle Name:DIANA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARQUINA
Other - Middle Name:ALVAREZ
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9317 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-3001
Mailing Address - Country:US
Mailing Address - Phone:310-222-3715
Mailing Address - Fax:
Practice Address - Street 1:1124 W CARSON ST # N28
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2006
Practice Address - Country:US
Practice Address - Phone:310-222-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant