Provider Demographics
NPI:1043393218
Name:ALFONSO P MIGUEL JR MD INC
Entity type:Organization
Organization Name:ALFONSO P MIGUEL JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:P
Authorized Official - Last Name:MIGUEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-3835
Mailing Address - Street 1:102 W ROUTE 66
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6247
Mailing Address - Country:US
Mailing Address - Phone:626-914-3835
Mailing Address - Fax:626-963-4613
Practice Address - Street 1:102 W ROUTE 66
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6247
Practice Address - Country:US
Practice Address - Phone:626-914-3835
Practice Address - Fax:626-963-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA230442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A230440Medicaid
CAA23044Medicare ID - Type Unspecified
A23376Medicare UPIN