Provider Demographics
NPI:1740242627
Name:ALLAVIE, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:ALLAVIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4605 BROCKTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0107
Mailing Address - Country:US
Mailing Address - Phone:951-686-4911
Mailing Address - Fax:951-686-9409
Practice Address - Street 1:4605 BROCKTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0107
Practice Address - Country:US
Practice Address - Phone:951-686-4911
Practice Address - Fax:951-686-9409
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG47555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G47550Medicaid
CA00G47550Medicaid