Healthcare Provider Details

I. General information

NPI: 1326244062
Provider Name (Legal Business Name): JOSE ALVAREZ DE LA LLANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 S EUCLID AVE STE A
ONTARIO CA
91762-5832
US

IV. Provider business mailing address

1749 S EUCLID AVE STE A
ONTARIO CA
91762-5832
US

V. Phone/Fax

Practice location:
  • Phone: 909-972-0300
  • Fax: 909-984-4878
Mailing address:
  • Phone: 909-972-0300
  • Fax: 909-984-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME98939
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA101657
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: