MEDICARE: LEISLY GUADALUPE ALVARADO

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
1	106S00000X	Behavior Technician	23-252662	CA

General Provider Information

NPI Number	:	1730942145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEISLY GUADALUPE ALVARADO

Provider Business Mailing Address
First Line	:	4856 W ADAMS BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2846
Country	:	US
Telephone Number	:	323-523-3566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S FREMONT AVE
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-8800
Country	:	US
Telephone Number	:	626-759-9154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/10/2026

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