Provider Demographics
NPI:1922260512
Name:ALFIERI, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ALFIERI
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 1:6719 ALVARADO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5256
Mailing Address - Country:US
Mailing Address - Phone:619-229-5018
Mailing Address - Fax:619-229-2968
Practice Address - Street 1:6719 ALVARADO RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5256
Practice Address - Country:US
Practice Address - Phone:619-229-5018
Practice Address - Fax:619-229-2968
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC161523207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032670990001Medicaid
PA1032670990001Medicaid