Provider Demographics
NPI:1871886382
Name:ALCANTAR, JOSE ANGEL
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:ALCANTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SWEETWATER RD STE D
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7655
Mailing Address - Country:US
Mailing Address - Phone:619-474-2233
Mailing Address - Fax:
Practice Address - Street 1:1615 SWEETWATER RD STE D
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7655
Practice Address - Country:US
Practice Address - Phone:619-474-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CA95003735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner