Provider Demographics
NPI:1578659066
Name:JACOBO-ALATRISTE, ANDRES N (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:N
Last Name:JACOBO-ALATRISTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-8517
Mailing Address - Country:US
Mailing Address - Phone:760-352-2257
Mailing Address - Fax:760-352-4759
Practice Address - Street 1:852 E DANENBERG DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-8517
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:760-352-4579
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ530642084N0400X
CAA454742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45474Medicaid
CAA45474Medicare ID - Type Unspecified
CAF68055Medicare UPIN