Provider Demographics
NPI:1982611521
Name:JALLORINA, ALDEN I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALDEN
Middle Name:I
Last Name:JALLORINA
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 1:16125 KAMANA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1377
Mailing Address - Country:US
Mailing Address - Phone:760-946-2600
Mailing Address - Fax:760-946-5600
Practice Address - Street 1:16125 KAMANA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1377
Practice Address - Country:US
Practice Address - Phone:760-946-2600
Practice Address - Fax:760-946-5600
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094067207R00000X
CAC52186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
374950OtherHEALTHLINK
1322319OtherBLUE CROSS BLUE SHIELD
023130OtherHEALTH ALLIANCE
IL036094067Medicaid
P00138368Medicare ID - Type UnspecifiedRAILROAD MEDICARE
1322319OtherBLUE CROSS BLUE SHIELD
G57720Medicare ID - Type Unspecified