Provider Demographics
NPI:1588765408
Name:ENGLANOFF, ALON (MD)
Entity type:Individual
Prefix:
First Name:ALON
Middle Name:
Last Name:ENGLANOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3622
Mailing Address - Country:US
Mailing Address - Phone:909-868-1160
Mailing Address - Fax:
Practice Address - Street 1:5211 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3959
Practice Address - Country:US
Practice Address - Phone:323-980-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine