Provider Demographics
NPI:1760514806
Name:ROJAS, ALVARO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:
Last Name:ROJAS
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 1:2912 QUEENSBURY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4522
Mailing Address - Country:US
Mailing Address - Phone:310-339-4794
Mailing Address - Fax:310-559-4266
Practice Address - Street 1:2912 QUEENSBURY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4522
Practice Address - Country:US
Practice Address - Phone:310-339-4794
Practice Address - Fax:310-559-4266
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26089208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260890Medicaid
CA00A260890Medicaid
CAA26089Medicare ID - Type UnspecifiedMEDICARE ID