Provider Demographics
NPI:1700156031
Name:MUTCHNIK, ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:MUTCHNIK
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 1:7317 ALMADEN LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6902
Mailing Address - Country:US
Mailing Address - Phone:760-438-3882
Mailing Address - Fax:760-438-2004
Practice Address - Street 1:7317 ALMADEN LN
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6902
Practice Address - Country:US
Practice Address - Phone:760-438-3882
Practice Address - Fax:760-438-2004
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39956208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice