Provider Demographics
NPI:1538573175
Name:ALVAREZ, EDWIN HAROLDO (PAC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:HAROLDO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31216 SILVER MOON COURT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584
Mailing Address - Country:US
Mailing Address - Phone:619-384-7877
Mailing Address - Fax:
Practice Address - Street 1:31216 SILVER MOON COURT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584
Practice Address - Country:US
Practice Address - Phone:619-384-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant