Healthcare Provider Details

I. General information

NPI: 1609376714
Provider Name (Legal Business Name): ROSANNA ALVAREZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17432 W ELAINE DR
GOODYEAR AZ
85338
US

IV. Provider business mailing address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

V. Phone/Fax

Practice location:
  • Phone: 602-684-6154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP030081
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number7649399
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number7649399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: