Alav Medical Corporation
Organization Active NPI Family Medicine Physician · Fontana, CA
NPI 1104016468 · NPPES record last updated Mar 30, 2018
Key facts
- NPI
- 1104016468
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A74033 (CA)
- Legal business name
- ALAV MEDICAL CORPORATION
- Practice address
- 16465 Sierra Lakes Pkwy
Ste 220
Fontana, CA 92336-1242 - Phone
- (909) 434-1123
- Fax
- (909) 261-8082
- NPI assigned
- Aug 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Faramarz Alav, MD
- Title
- President
- Phone
- (909) 261-8082
Practitioners 2
-
Faramarz Alav, M.D.
-
Basem R. Farag, M.D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1079199 | Alav Medical Corporation | Certificate of waiver | Jan 27, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080108000520 | CA | Part B Supplier - Clinic/Group Practice | 1951481571 |
Receives reassigned benefits from 1 practitioner Practice locations: Fontana, CA |
National Provider Directory
Locations
16465 Sierra Lakes Pkwy
Ste 20
Fontana, CA 92336
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | A74033 | CA | Yes |
Addresses
Primary practice location
16465 Sierra Lakes Pkwy
Ste 220
Fontana, CA 92336-1242
Mailing address
16465 Sierra Lakes Pkwy Ste 200
Fontana, CA 92336-1242
Phone (909) 429-2404
Other providers in Fontana, CA
- Erica Alade
- Nathan Alagao
- Ziyad H Alam
- Heyzel Alarcon
- Brandie Bernice Alarrabiyyat
- Faramarz Alav
- Christopher G Albaugh
- Rita Riad Albert
- Lawrence H. Albinski
- Nicole Ninofranco Alcantara
All providers in Fontana, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.