Provider Demographics
NPI:1801804901
Name:ALVAREZ, FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:ALVAREZ
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 1:1832 BUENAVENTURA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3828
Mailing Address - Country:US
Mailing Address - Phone:530-242-4682
Mailing Address - Fax:
Practice Address - Street 1:1832 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3828
Practice Address - Country:US
Practice Address - Phone:530-242-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71517174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G715170Medicaid
CA110182090OtherRAILROAD MEDICARE NUMBER
CAG71517OtherMEDICAL LISENCE
CAF36718Medicare UPIN