Provider Demographics
NPI:1609834217
Name:ALARCON, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:ALARCON
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 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:714-841-5471
Mailing Address - Fax:714-841-7661
Practice Address - Street 1:2133 W BEVERLY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3901
Practice Address - Country:US
Practice Address - Phone:626-284-9278
Practice Address - Fax:626-284-9746
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40197208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401970Medicaid
A29074Medicare UPIN
CA00A401970Medicaid