Provider Demographics
NPI:1063064483
Name:ALVA, ELYSIA TRUONG MCNULTY (PA-C)
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:TRUONG MCNULTY
Last Name:ALVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELYSIA
Other - Middle Name:TRUONG
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0221
Mailing Address - Country:US
Mailing Address - Phone:408-348-9881
Mailing Address - Fax:
Practice Address - Street 1:260 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-972-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant