Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 154770 | CA |
N | 207RI0011X | Interventional Cardiology | 154770 | CA |
NPI | 1093714743 |
---|---|
Provider Name | Dr. Alvaro Daniel Waissbluth |
First Address | Hayward, CA 94544-6666 |
Second Address | Alameda, CA 94501-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000524485 | ANTHEM (01) | OH |
200248900 | (05) | IN |
208679830029 | CARESOURCE (01) | OH |
2149802 | (05) | OH |
2149802 | MOLINA HEALTHCARE (01) | OH |
283931 | AMERIGROUP (01) | OH |
64009624 | (05) | KY |
G40719 | (02) |