Provider Demographics
NPI:1245397496
Name:LOGIHEALTH
Entity Type:Organization
Organization Name:LOGIHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:NMD RCP
Authorized Official - Phone:951-488-1500
Mailing Address - Street 1:12730 HEACOCK ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3040
Mailing Address - Country:US
Mailing Address - Phone:951-488-1500
Mailing Address - Fax:
Practice Address - Street 1:12730 HEACOCK ST
Practice Address - Street 2:SUITE #4
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3040
Practice Address - Country:US
Practice Address - Phone:951-488-1500
Practice Address - Fax:951-488-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45442207R00000X
CAF19330207RP1001X
261QM1300X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic