Provider Demographics
NPI:1245561752
Name:ELISA C ALVARADO MD INC
Entity Type:Organization
Organization Name:ELISA C ALVARADO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-584-0026
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-584-0026
Mailing Address - Fax:626-584-6166
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-584-0026
Practice Address - Fax:626-584-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA98438OtherSTATE LICENSE
CAA98438OtherSTATE LICENSE