Provider Demographics
NPI:1528151511
Name:PAVILION FAMILY PHYSICIANS MEDICAL GROUP INC.
Entity type:Organization
Organization Name:PAVILION FAMILY PHYSICIANS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-547-5404
Mailing Address - Street 1:1140 W LA VETA
Mailing Address - Street 2:#700
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-547-5404
Mailing Address - Fax:714-547-0935
Practice Address - Street 1:1140 W LA VETA AVE STE 700
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4229
Practice Address - Country:US
Practice Address - Phone:714-547-5404
Practice Address - Fax:714-547-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A85474Medicare UPIN
A93494Medicare UPIN
G07952Medicare UPIN
F89538Medicare UPIN
C46830Medicare UPIN
F70718Medicare UPIN