Basic Information
Provider Information
NPI: 1588197826
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALVAREZ-ESTRADA
FirstName: MIGUEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D., M.B.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 480 FOURTH AVE STE 403
Address2:  
City: CHULA VISTA
State: CA
PostalCode: 919104413
CountryCode: US
TelephoneNumber: 6196917479
FaxNumber:  
Practice Location
Address1: 480 FOURTH AVE STE 403
Address2:  
City: CHULA VISTA
State: CA
PostalCode: 919104413
CountryCode: US
TelephoneNumber: 6196917479
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/04/2017
LastUpdateDate: 07/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA157505CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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