Provider Demographics
NPI:1962538173
Name:ALFREDO SWEENY, MD INC
Entity type:Organization
Organization Name:ALFREDO SWEENY, MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:SWEENY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-231-9983
Mailing Address - Street 1:4719 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3244
Mailing Address - Country:US
Mailing Address - Phone:323-231-9983
Mailing Address - Fax:323-231-9971
Practice Address - Street 1:4719 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3244
Practice Address - Country:US
Practice Address - Phone:323-231-9983
Practice Address - Fax:323-231-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A250701Medicaid
CAGR0089100Medicaid