Provider Demographics
NPI:1235351206
Name:ALFARO- MCFIELD, EDGAR EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:EDUARDO
Last Name:ALFARO- MCFIELD
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 1:1800 WESTERN AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1354
Mailing Address - Country:US
Mailing Address - Phone:909-880-9993
Mailing Address - Fax:909-880-9998
Practice Address - Street 1:1800 WESTERN AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1354
Practice Address - Country:US
Practice Address - Phone:909-880-9993
Practice Address - Fax:909-880-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235351206Medicaid
CAGR0062066Medicaid
CA1528238961Medicaid
CAA100540OtherCA MED LIC
CAZZZ70178ZOtherBS/TRIWEST
CAZZZ70178ZMedicare PIN