1518326602 NPI number — ALVAREZ & BERNARDO DENTAL CORPORATION

Table of content: (NPI 1518326602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518326602 NPI number — ALVAREZ & BERNARDO DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVAREZ & BERNARDO DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1518326602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 520
Provider Second Line Business Mailing Address:
1200 E. WASHINGTON ST., STE. F-2
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-422-0885
Provider Business Mailing Address Fax Number:
909-422-0890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E. WASHINGTON ST.
Provider Second Line Business Practice Location Address:
STE. F-2
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324-0520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-422-0885
Provider Business Practice Location Address Fax Number:
909-422-0885
Provider Enumeration Date:
02/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BERNARDO
Authorized Official First Name:
SERAFIN
Authorized Official Middle Name:
LABAO
Authorized Official Title or Position:
PRESIDENT/OWNER/DENTIST
Authorized Official Telephone Number:
909-422-0885

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  37788 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 37788 , 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: 1134261480 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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