Healthcare Provider Details

I. General information

NPI: 1619600608
Provider Name (Legal Business Name): GABRIEL ALARCON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 VANOWEN ST
VAN NUYS CA
91405-4542
US

IV. Provider business mailing address

3350 WILSHIRE BLVD APT 813
LOS ANGELES CA
90010-4208
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-6600
  • Fax:
Mailing address:
  • Phone: 843-576-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: