Provider Demographics
NPI:1689750796
Name:ALEJANDRO, E. ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:E. ALLEN
Middle Name:
Last Name:ALEJANDRO
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 1:1800 WESTERN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1356
Mailing Address - Country:US
Mailing Address - Phone:909-473-8618
Mailing Address - Fax:909-473-3107
Practice Address - Street 1:1800 WESTERN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1356
Practice Address - Country:US
Practice Address - Phone:909-473-8618
Practice Address - Fax:909-473-3107
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29412Medicare UPIN