Provider Demographics
NPI:1720189939
Name:ALVARELLOS, MIGUEL ANGEL DARIO (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL DARIO
Last Name:ALVARELLOS
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 1:8502 E CHAPMAN AVE # 235
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2461
Mailing Address - Country:US
Mailing Address - Phone:310-222-1605
Mailing Address - Fax:714-838-8830
Practice Address - Street 1:260 COHASSET RD STE 120
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2282
Practice Address - Country:US
Practice Address - Phone:530-894-5933
Practice Address - Fax:714-838-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA945242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A94524Medicaid