Basic Information
| Provider Information | |||||||||
| NPI: | 1225614985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALSINA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | LAZARO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 LEE ST | ||||||||
| Address2: | MAIL STOP 800793 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349241955 | ||||||||
| FaxNumber: | 4349821841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 LEE ST | ||||||||
| Address2: | MAIL STOP 800793 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349241955 | ||||||||
| FaxNumber: | 4349821841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 05/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 0116035029 | VA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.