Provider Demographics
NPI:1376884072
Name:GUSTAVO ALVA, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GUSTAVO ALVA, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-545-5550
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:SUITE T3
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4627
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:714-545-5748
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:SUITE T3
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4627
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:714-545-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty