Provider Demographics
NPI:1851464838
Name:NATIVIDAD, ALBERTO V (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:V
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1711 W TEMPLE ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-989-1951
Mailing Address - Fax:213-989-1987
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-989-1951
Practice Address - Fax:213-989-1987
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A404580Medicaid
CA00A404580Medicaid
CAA40458AMedicare ID - Type Unspecified