Provider Demographics
NPI:1891979746
Name:ALVARADO, ELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:CUELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-584-0026
Mailing Address - Fax:626-584-6166
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-584-0026
Practice Address - Fax:626-584-6166
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0452Medicare PIN