Provider Demographics
NPI:1174554414
Name:ALVAREZ, JUAN ANTONIO (PA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3275 MCCALL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2505
Mailing Address - Country:US
Mailing Address - Phone:559-896-3808
Mailing Address - Fax:559-896-3875
Practice Address - Street 1:3275 MCCALL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2505
Practice Address - Country:US
Practice Address - Phone:559-896-3808
Practice Address - Fax:559-896-3875
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16914363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical