Healthcare Provider Details

I. General information

NPI: 1518302629
Provider Name (Legal Business Name): CARLOS ALVAREZ MD A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 7TH ST
WASCO CA
93280-1819
US

IV. Provider business mailing address

1147 7TH ST
WASCO CA
93280-1819
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-2449
  • Fax: 661-758-8317
Mailing address:
  • Phone: 661-758-2449
  • Fax: 661-758-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA42986
License Number StateCA

VIII. Authorized Official

Name: CARLOS ALVAREZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 661-758-2449