Provider Demographics
NPI:1720588098
Name:LOUIE, ALWIN (DO)
Entity Type:Individual
Prefix:
First Name:ALWIN
Middle Name:
Last Name:LOUIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1202
Mailing Address - Country:US
Mailing Address - Phone:909-887-6494
Mailing Address - Fax:
Practice Address - Street 1:1505 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1202
Practice Address - Country:US
Practice Address - Phone:909-887-6494
Practice Address - Fax:909-887-6043
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A17952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program