Healthcare Provider Details

I. General information

NPI: 1891979746
Provider Name (Legal Business Name): ELISA C ALVARADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELISA CUELLAR M.D.

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 HUNTINGTON DR STE 10
SAN MARINO CA
91108-2655
US

IV. Provider business mailing address

2233 HUNTINGTON DR STE 10
SAN MARINO CA
91108-2655
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-0026
  • Fax: 626-584-6166
Mailing address:
  • Phone: 626-584-0026
  • Fax: 626-584-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA98438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: