1609889518 NPI number — ALAN MARE M.D.

Table of content: ALAN MARE M.D. (NPI 1609889518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609889518 NPI number — ALAN MARE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARE
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609889518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN PEDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90734-6388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-225-3244
Provider Business Mailing Address Fax Number:
310-225-3244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1117 E DEVONSHIRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92543-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-925-6317
Provider Business Practice Location Address Fax Number:
951-765-4829
Provider Enumeration Date:
08/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X , with the licence number:  G10943 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: G10943 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G109430 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".