Healthcare Provider Details

I. General information

NPI: 1235191883
Provider Name (Legal Business Name): ALEJANDRO R PRIETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GLADSTONE DR SUITE 3
PITTSBURG CA
94565-5123
US

IV. Provider business mailing address

2220 GLADSTONE DR SUITE 3
PITTSBURG CA
94565-5123
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-3318
  • Fax: 925-432-4590
Mailing address:
  • Phone: 925-432-3318
  • Fax: 925-432-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAP063730
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM-2053
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM-2053
License Number StateGU
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberAP063730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: