Provider Demographics
NPI:1487843553
Name:ALVARADO SURGICAL ASSOCIATES, A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ALVARADO SURGICAL ASSOCIATES, A MEDICAL GROUP, INC.
Other - Org Name:WITTGROVE BARIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WITTGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-554-1770
Mailing Address - Street 1:9834 GENESEE AVE STE 328
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1216
Mailing Address - Country:US
Mailing Address - Phone:858-554-1770
Mailing Address - Fax:
Practice Address - Street 1:9834 GENESEE AVE STE 328
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1216
Practice Address - Country:US
Practice Address - Phone:858-554-1770
Practice Address - Fax:858-554-1771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVARADO SURGICAL ASSOCIATES, A MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty