Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A146687 | CA |
NPI | 1306229844 |
---|---|
Provider Name | Dr. Jason Paul Alvarado |
First Address | Harbor City, CA 90710-2076 |
Second Address | Harbor City, CA 90710-2076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2015 |
Last Update Date | 21/08/2019 |