Organization
PACORPNATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOISES ALVAREZ-FERNANDEZ (CEO)
(559) 920-2873
Entity
Organization
Contact information
Practice address
12665 GARDEN GROVE BLVD STE 713, GARDEN GROVE, CA 92843-1921
(714) 537-7500
(714) 537-2176
Mailing address
901 S HARBOR BLVD APT 223, SANTA ANA, CA 92704-2371
(559) 920-2873
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21762
CA
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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