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General NPI Number Information
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NPI Number | 1275709503
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Entity Type | Organization
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Legal Business Name | ALVARADO EYE ASSOCIATES MED CLINIC INC.
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 801 ORANGE AVE SUITE 204
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City | CORONADO
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State | CA
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Zip | 92118-2663
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Country | US
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Telephone | 619-437-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 7877 PARKWAY DR SUITE 100
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City | LA MESA
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State | CA
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Zip | 91942-2000
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Country | US
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Telephone | 619-286-3711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLENN B COOK
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Credential | MD
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Telephone | 619-286-3712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G063727
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License Number State | CA
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