Provider Demographics
NPI:1558502716
Name:J. ANTONIO ALARCON, MD INC
Entity Type:Organization
Organization Name:J. ANTONIO ALARCON, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EMERZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-375-6280
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:90743-0303
Mailing Address - Country:US
Mailing Address - Phone:714-375-6280
Mailing Address - Fax:
Practice Address - Street 1:2133 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3901
Practice Address - Country:US
Practice Address - Phone:323-201-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA401970208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401970Medicaid