Healthcare Provider Details

I. General information

NPI: 1679266829
Provider Name (Legal Business Name): JESUS ALVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

IV. Provider business mailing address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8080
  • Fax:
Mailing address:
  • Phone: 661-546-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: