Healthcare Provider Details

I. General information

NPI: 1780727305
Provider Name (Legal Business Name): MRS. BEATRICE ALICIA NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S SANTA ANITA AVE
ARCADIA CA
91006-6853
US

IV. Provider business mailing address

308 LANG AVE
LA PUENTE CA
91744-3419
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-5049
  • Fax:
Mailing address:
  • Phone: 626-968-9579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: