Provider Demographics
NPI:1649200379
Name:ALVA, FEDERICO (MD)
Entity type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:
Last Name:ALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FEDERICO
Other - Middle Name:
Other - Last Name:ALVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:#203
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4108
Mailing Address - Country:US
Mailing Address - Phone:818-349-5228
Mailing Address - Fax:818-349-2551
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:#203
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-349-5228
Practice Address - Fax:818-349-2551
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA031407207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A30407Medicaid
CAA26467Medicare UPIN
CAA31407Medicare ID - Type Unspecified