Provider Demographics
NPI:1245228519
Name:TOVAR, ALEXANDER S (M D)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:S
Last Name:TOVAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:S
Other - Last Name:TOVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:201 S. BUENA VISTA ST
Mailing Address - Street 2:STE #425
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-848-8311
Mailing Address - Fax:818-848-3314
Practice Address - Street 1:201 S. BUENA VISTA ST
Practice Address - Street 2:STE #425
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-848-8311
Practice Address - Fax:818-848-3314
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G575580OtherMEDI-CAL
CA00G575580OtherMEDI-CAL
CAE48508Medicare UPIN