Healthcare Provider Details

I. General information

NPI: 1093714743
Provider Name (Legal Business Name): ALVARO DANIEL WAISSBLUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE FL 3
ALAMEDA CA
94501-4399
US

IV. Provider business mailing address

30287 CEDARBROOK RD
HAYWARD CA
94544-6666
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-6323
  • Fax:
Mailing address:
  • Phone: 650-922-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number154770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number154770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: