Provider Demographics
NPI:1225504301
Name:ALFRED, AMGAD (PA-C)
Entity type:Individual
Prefix:
First Name:AMGAD
Middle Name:
Last Name:ALFRED
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3137
Mailing Address - Country:US
Mailing Address - Phone:909-480-4808
Mailing Address - Fax:909-480-4843
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-480-4808
Practice Address - Fax:909-480-4843
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56123363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant