MEDICARE: ALPA MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1528886967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5078 MANOR RIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2896
Country	:	US
Telephone Number	:	949-562-4039
Fax Number	:	949-239-7799

Provider Business Practice Location Address
First Line	:	5078 MANOR RIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2896
Country	:	US
Telephone Number	:	858-630-8940
Fax Number	:	949-239-7799

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI ALAVI
Credential	:	MD
Telephone Number	:	949-562-4039

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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