Basic Information
| Provider Information | |||||||||
| NPI: | 1124009923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALVIDREZ | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 Q STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933011645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235918 | ||||||||
| FaxNumber: | 6613234703 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 ADKISSON WAY | ||||||||
| Address2: | |||||||||
| City: | TAFT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932683602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617651935 | ||||||||
| FaxNumber: | 6617651928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A87759 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00228421 | 01 | CA | RAILROAD MEDICARE | OTHER | 00A877590 | 05 | CA | MEDICAID |