Provider Demographics
NPI:1851957716
Name:GAVRALIDIS, ALEXANDER (MD)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:GAVRALIDIS
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 1:2700 IOWA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7006
Mailing Address - Country:US
Mailing Address - Phone:617-952-3355
Mailing Address - Fax:978-825-6312
Practice Address - Street 1:11234 ANDERSON ST # 11015
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-5413
Practice Address - Fax:909-558-0219
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184858207R00000X, 207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program