Provider Demographics
NPI:1275743932
Name:ALFARO, JULIAN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:JAVIER
Last Name:ALFARO
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:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-0140
Mailing Address - Country:US
Mailing Address - Phone:760-861-1436
Mailing Address - Fax:760-289-6203
Practice Address - Street 1:51544 CESAR CHAVEZ ST STE 1D
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1504
Practice Address - Country:US
Practice Address - Phone:760-861-1436
Practice Address - Fax:760-289-6203
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-09-13
Deactivation Date:2022-08-02
Deactivation Code:
Reactivation Date:2022-08-30
Provider Licenses
StateLicense IDTaxonomies
CAA97986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A979860Medicaid
CA00A979860Medicaid