Provider Demographics
NPI:1558518910
Name:TLALOC ALFEREZ,MD APMC
Entity type:Organization
Organization Name:TLALOC ALFEREZ,MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TLALOC
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALFEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-943-9557
Mailing Address - Street 1:PO BOX 15920
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-5920
Mailing Address - Country:US
Mailing Address - Phone:504-943-9578
Mailing Address - Fax:
Practice Address - Street 1:3407 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-6144
Practice Address - Country:US
Practice Address - Phone:504-943-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016902207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1362077Medicaid
LA5CC78Medicare PIN
LAB63619Medicare UPIN