Provider Demographics
NPI:1780771659
Name:ALVARADO, JUAN A (PA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1528
Mailing Address - Country:US
Mailing Address - Phone:323-526-9770
Mailing Address - Fax:323-526-4646
Practice Address - Street 1:2935 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1528
Practice Address - Country:US
Practice Address - Phone:323-526-9770
Practice Address - Fax:323-526-4646
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant