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NPI Code Detail

MEDICARE: MISS IRIS JOANNE ALVAREZ B.A., BCABA

MEDICARE: MISS IRIS JOANNE ALVAREZ B.A., BCABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst0-11-4117CA
2103K00000XBehavior Analyst1-14-16232CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-14-16232OTHERCABCBA CERTIFICATE NUMBER

General Provider Information

NPI Number : 1154677565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS IRIS JOANNE ALVAREZ B.A., BCABA
Provider Business Mailing Address
First Line : 15643 SHERMAN WAY STE 220
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-4174
Country : US
Telephone Number : 818-232-7940
Fax Number : 818-782-9985
Provider Business Practice Location Address
First Line : 5554 RESEDA BLVD STE 203
Second Line :
City : TARZANA
State : CA
Zip : 91356-6212
Country : US
Telephone Number : 818-705-5522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 05/03/2018

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