Provider Demographics
NPI:1215099494
Name:ALVA, KATHLEEN C (PA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:C
Last Name:ALVA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: MCMF - CREDENTIALING DEPARTMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31001 RANCHO VIEJO RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-661-9611
Practice Address - Fax:949-443-6200
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABI015XMedicare PIN
CAWPA18629AMedicare PIN