Provider Demographics
NPI:1588989487
Name:CODA, ALVIN BOB (MD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:BOB
Last Name:CODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8899 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1013
Mailing Address - Country:US
Mailing Address - Phone:858-657-8322
Mailing Address - Fax:
Practice Address - Street 1:10820 N TORREY PINES RD # MS 128
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1036
Practice Address - Country:US
Practice Address - Phone:858-554-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118265207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology