Provider Demographics
NPI:1447408950
Name:PADUA, ALVINA G
Entity Type:Individual
Prefix:DR
First Name:ALVINA
Middle Name:G
Last Name:PADUA
Suffix:
Gender:F
Credentials:
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 504
Mailing Address - Street 2:61 S.BALDWIN AVE.
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91025-0504
Mailing Address - Country:US
Mailing Address - Phone:626-975-9942
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2248
Practice Address - Country:US
Practice Address - Phone:626-975-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice