Provider Demographics
NPI:1508865759
Name:CHAVIRA, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:CHAVIRA
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 1:334 VIA VERA CRUZ
Mailing Address - Street 2:SUITE 257
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2635
Mailing Address - Country:US
Mailing Address - Phone:760-510-1808
Mailing Address - Fax:760-510-1811
Practice Address - Street 1:334 VIA VERA CRUZ
Practice Address - Street 2:SUITE 257
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2635
Practice Address - Country:US
Practice Address - Phone:760-510-1808
Practice Address - Fax:760-510-1811
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-01-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CAG50302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G503020Medicaid
CA00G503020Medicaid
CAA92960Medicare UPIN