Basic Information
Provider Information
NPI: 1538588561
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALVARADO
FirstName: JORGE
MiddleName: LUIS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O.BOX 232410
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 92193
CountryCode: US
TelephoneNumber: 6195437878
FaxNumber:  
Practice Location
Address1: 1001 POTRERO AVE # 6D
Address2: SFGH OB GYN
City: SAN FRANCISCO
State: CA
PostalCode: 941103518
CountryCode: US
TelephoneNumber: 4152064069
FaxNumber: 4154761811
Other Information
ProviderEnumerationDate: 04/07/2014
LastUpdateDate: 07/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XA139473CAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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