Healthcare Provider Details

I. General information

NPI: 1245397496
Provider Name (Legal Business Name): LOGIHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 HEACOCK ST SUITE #4
MORENO VALLEY CA
92553-3040
US

IV. Provider business mailing address

12730 HEACOCK ST SUITE #4
MORENO VALLEY CA
92553-3040
US

V. Phone/Fax

Practice location:
  • Phone: 951-488-1500
  • Fax: 951-488-1556
Mailing address:
  • Phone: 951-488-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA45442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberF19330
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANTIAGO ALVAREZ
Title or Position: GENERAL MANAGER
Credential: NMD. RCP
Phone: 951-488-1500