Healthcare Provider Details

I. General information

NPI: 1689671380
Provider Name (Legal Business Name): JOHN G ALEVIZOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15751 ROCKFIELD BLVD SUITE 100
IRVINE CA
92618-2832
US

IV. Provider business mailing address

800 N TUSTIN AVE SUITE A
SANTA ANA CA
92705-3605
US

V. Phone/Fax

Practice location:
  • Phone: 949-206-9100
  • Fax: 949-206-1648
Mailing address:
  • Phone: 714-245-0800
  • Fax: 714-285-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A6108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number20A6108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: