Provider Demographics
NPI:1487726394
Name:ALANIZ, JORGE E (DPM)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:ALANIZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37138 NILES BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1616
Mailing Address - Country:US
Mailing Address - Phone:510-795-7099
Mailing Address - Fax:510-795-1978
Practice Address - Street 1:37138 NILES BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1616
Practice Address - Country:US
Practice Address - Phone:510-795-7099
Practice Address - Fax:510-795-1978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2644213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E26440Medicaid
CA000E26440Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
CAT11417Medicare UPIN
CA000E26440Medicaid