Healthcare Provider Details

I. General information

NPI: 1952919763
Provider Name (Legal Business Name): JOHN G. ALEVIZOS, D.O., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 EAST EDINGER AVENUE SUITE 1
SANTA ANA CA
92705
US

IV. Provider business mailing address

1530 EAST EDINGER AVENUE SUITE 1
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-0400
  • Fax: 714-542-0038
Mailing address:
  • Phone: 714-442-0400
  • Fax: 714-542-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN G ALEVIZOS
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: D.O.
Phone: 949-916-3600