Healthcare Provider Details

I. General information

NPI: 1063725661
Provider Name (Legal Business Name): CYNTHIA ALVAREZ CLEGG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 S MARENGO AVE
ALHAMBRA CA
91803-3096
US

IV. Provider business mailing address

1300 N VERMONT AVE STE 506
LOS ANGELES CA
90027-6098
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-1032
  • Fax:
Mailing address:
  • Phone: 213-989-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19492
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: