1275743932 NPI number — DR. JULIAN JAVIER ALFARO MD

Table of content: ALEXANDRA MARIE KAUAIANIANI ZUKERMAN PTA (NPI 1184929366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275743932 NPI number — DR. JULIAN JAVIER ALFARO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALFARO
Provider First Name:
JULIAN
Provider Middle Name:
JAVIER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1275743932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/02/2022
NPI Reactivation Date:
08/30/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COACHELLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92236-0140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-861-1436
Provider Business Mailing Address Fax Number:
760-289-6203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51544 CESAR CHAVEZ ST STE 1D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COACHELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92236-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-861-1436
Provider Business Practice Location Address Fax Number:
760-289-6203
Provider Enumeration Date:
05/23/2007

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: 207Q00000X , with the licence number:  A97986 , 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: 00A979860 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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