Provider Demographics
NPI:1578659066
Name:JACOBO-ALATRISTE, ANDRES N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:N
Last Name:JACOBO-ALATRISTE
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2329
Mailing Address - Country:US
Mailing Address - Phone:928-783-0092
Mailing Address - Fax:760-336-2284
Practice Address - Street 1:2503 S AVENUE A STE 2
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7174
Practice Address - Country:US
Practice Address - Phone:928-783-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA454742084N0400X
AZ530642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45474Medicaid
CAA45474Medicare ID - Type Unspecified
CAF68055Medicare UPIN