Provider Demographics
NPI:1952950479
Name:ALVARADO, CARLOS DE JESUS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:DE JESUS
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-2023
Mailing Address - Country:US
Mailing Address - Phone:323-233-3100
Mailing Address - Fax:323-233-4100
Practice Address - Street 1:2801 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-2023
Practice Address - Country:US
Practice Address - Phone:323-233-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant