MEDICARE: DR. ALEX H. ETEMAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	C50563	CA

General Provider Information

NPI Number	:	1528032562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX H. ETEMAD M.D.

Provider Business Mailing Address
First Line	:	16702 VALLEY VIEW AVE
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-5824
Country	:	US
Telephone Number	:	714-367-5360
Fax Number	:	714-635-5428

Provider Business Practice Location Address
First Line	:	5584 N PARAMOUNT BLVD
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90805-5133
Country	:	US
Telephone Number	:	562-920-8394
Fax Number	:	562-867-6083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/21/2022

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