Healthcare Provider Details

I. General information

NPI: 1871886382
Provider Name (Legal Business Name): MR. JOSE ANGEL ALCANTAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SWEETWATER RD STE D
NATIONAL CITY CA
91950-7655
US

IV. Provider business mailing address

1615 SWEETWATER RD STE D
NATIONAL CITY CA
91950-7655
US

V. Phone/Fax

Practice location:
  • Phone: 619-474-2233
  • Fax:
Mailing address:
  • Phone: 619-474-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: