Provider Demographics
NPI:1497802094
Name:DE LA LLANA, ANDRES GAVINO ALVAREZ (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES GAVINO
Middle Name:ALVAREZ
Last Name:DE LA LLANA
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 1:17095 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-948-4616
Practice Address - Street 1:19333 BEAR VALLEY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0000
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-241-7575
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEQ823YMedicare PIN