Provider Demographics
NPI:1528011020
Name:URIOSTE, ALEXANDER S (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:S
Last Name:URIOSTE
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 1:7777 ALVARADO RD
Mailing Address - Street 2:#108
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-460-2770
Mailing Address - Fax:619-460-2774
Practice Address - Street 1:8881 FLETCHER PARKWAY
Practice Address - Street 2:#102
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-461-1830
Practice Address - Fax:619-797-1484
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA787952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787950OtherBLUE SHIELD PIN
CA00A787950Medicaid
P00333290Medicare PIN
WA78795BMedicare PIN
138088Medicare UPIN
CAWA78795CMedicare PIN
WA78795CMedicare PIN
CAWA78795DMedicare PIN
CA00A787950OtherBLUE SHIELD PIN
CAI38088Medicare UPIN
WA78795AMedicare PIN
CAP00333290Medicare PIN