Provider Demographics
NPI:1932172517
Name:ALVAREZ LEON, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ALVAREZ LEON
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 1:817 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4512
Mailing Address - Country:US
Mailing Address - Phone:562-435-1774
Mailing Address - Fax:562-435-6015
Practice Address - Street 1:817 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4512
Practice Address - Country:US
Practice Address - Phone:562-435-1774
Practice Address - Fax:562-435-6015
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40450208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C404500Medicaid
A04026Medicare UPIN
CAC40450AMedicare ID - Type Unspecified