Provider Demographics
NPI:1720189186
Name:ALAS-POCASANGRE, JUAN ATLACATL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ATLACATL
Last Name:ALAS-POCASANGRE
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 1:18335 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5968
Mailing Address - Country:US
Mailing Address - Phone:626-810-3330
Mailing Address - Fax:626-964-0440
Practice Address - Street 1:18335 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5968
Practice Address - Country:US
Practice Address - Phone:626-810-3330
Practice Address - Fax:626-964-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561550Medicaid
CAW10954Medicare ID - Type Unspecified
CAI37200Medicare UPIN