Provider Demographics
NPI:1881695401
Name:ALAS, JUAN LEMPIRA
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:LEMPIRA
Last Name:ALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2939
Mailing Address - Country:US
Mailing Address - Phone:626-815-1511
Mailing Address - Fax:626-815-1504
Practice Address - Street 1:545 N SAN GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2939
Practice Address - Country:US
Practice Address - Phone:626-815-1511
Practice Address - Fax:626-815-1504
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16600Medicare ID - Type Unspecified
X97279Medicare UPIN