Provider Demographics
NPI: | 1780122960 |
---|---|
Name: | DR ALVAREZ |
Entity type: | Organization |
Organization Name: | DR ALVAREZ |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRIMARY CARE DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CARLOS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALVAREZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 661-489-5999 |
Mailing Address - Street 1: | 5400 ALDRIN CT |
Mailing Address - Street 2: | |
Mailing Address - City: | BAKERSFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93313-2103 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-489-5999 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5400 ALDRIN CT |
Practice Address - Street 2: | |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93313-2103 |
Practice Address - Country: | US |
Practice Address - Phone: | 666-142-8599 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-02-07 |
Last Update Date: | 2019-01-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 95004591 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |