Provider Demographics
NPI:1225131535
Name:ALFARO, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:
Last Name:ALFARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 BALBOA BLVD
Mailing Address - Street 2:504
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-363-3000
Mailing Address - Fax:580-821-5524
Practice Address - Street 1:14435 HAMLIN ST
Practice Address - Street 2:108
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-997-7117
Practice Address - Fax:888-833-2881
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24516207R00000X
CAA84818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059420BMedicaid
OK200059420BMedicaid
OK200059420BMedicaid