Basic Information
| Provider Information | |||||||||
| NPI: | 1689671380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEVIZOS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N TUSTIN AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142450800 | ||||||||
| FaxNumber: | 7142850400 | ||||||||
| Practice Location | |||||||||
| Address1: | 15751 ROCKFIELD BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492069100 | ||||||||
| FaxNumber: | 9492061648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 20A6108 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 2083P0500X | 20A6108 | CA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20A6108 | 01 | CA | MEDICAL LICENSE | OTHER |