Provider Demographics
NPI:1356462576
Name:ALFREDO Y JOSE MD AMC
Entity Type:Organization
Organization Name:ALFREDO Y JOSE MD AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-1373
Mailing Address - Street 1:500 N GARFIELD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-288-1373
Mailing Address - Fax:626-288-5236
Practice Address - Street 1:500 N GARFIELD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-288-1373
Practice Address - Fax:626-288-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24476208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A244760Medicaid
CA00A244760Medicaid
A23996Medicare UPIN