Provider Demographics
NPI:1316151756
Name:ALVARADO MEDICAL GROUP,INC
Entity type:Organization
Organization Name:ALVARADO MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-229-5055
Mailing Address - Street 1:6386 ALVARADO CT
Mailing Address - Street 2:STE. 310
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4905
Mailing Address - Country:US
Mailing Address - Phone:619-229-5050
Mailing Address - Fax:619-287-0833
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:STE. 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4905
Practice Address - Country:US
Practice Address - Phone:619-229-5050
Practice Address - Fax:619-287-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW680Medicare ID - Type UnspecifiedMEDICARE ID#