Healthcare Provider Details

I. General information

NPI: 1417351073
Provider Name (Legal Business Name): ALVARADO PHYSICIANS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2309
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

6699 ALVARADO RD STE 2309
SAN DIEGO CA
92120-5241
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-8803
  • Fax: 619-286-2344
Mailing address:
  • Phone: 619-286-8803
  • Fax: 619-286-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KLEVEN
Title or Position: CFO
Credential:
Phone: 619-229-3115